Left Ventricular Filling Pressure Estimation at Rest and During Exercise in Patients With Severe Aortic Valve Stenosis: Comparison of Echocardiographic and Invasive Measurements

Dalsgaard, Morten; Kjærgaard, Jesper; Pecini, Redi; Iversen, Kasper; Køber, Lars; Møller, Jacob Eifer; Grande, Peer; Clemmensen, Peter; Hassager, Christian

doi:10.1016/j.echo.2009.01.007

Cited by 67 publications

(50 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, at a later stage, LV hypertrophy may be no longer sufficient to compensate the afterload and increase in LV wall stress and filling pressure may occur resulting in symptoms and poor outcome. The E/e′ ratio is recognized as a noninvasive measurement of LV filling pressure in patients with AS [5,6] and the BNP activation is known to be a good surrogate marker of the occurrence of symptoms [6,7]. Consistently, our results have shown that the main determinant of BNP level is the estimated LV filing pressure using E/e′ ratio.…”

supporting

confidence: 75%

See 1 more Smart Citation

Brain natriuretic peptide release in patients with aortic stenosis: Resting and exercise echocardiographic determinants

Henri

Magné

Laaraibi

et al. 2014

International Journal of Cardiology

View full text Add to dashboard Cite

Aortic stenosis (AS) is the most common valvular heart disease in western countries [1]. Recent series reported that early surgery, i.e. aortic valve replacement (AVR) in asymptomatic patients and preserved left ventricular (LV) function, was associated with improved clinical outcomes [2,3]. Although AVR is safe and widely performed, the rates of both operative mortality and valve-related complications cannot be overlooked. The risk-benefit ratio of early strategy should be carefully evaluated and the decision-making could be refined by quantitative and reliable parameters. In this regard, the recently updated ESC guidelines suggest the usefulness of B-type natriuretic peptide (BNP) level measurement [4]. The aim of this study was to identify resting and exercise echocardiographic determinants of BNP level in asymptomatic patients with AS and preserved LV function.We prospectively included 61 asymptomatic patients with at least moderate AS (aortic valve area b1.5 cm 2 ) and preserved LV ejection fraction (N50%) that were referred to our Heart Valve Clinic to perform resting and exercise Doppler echocardiography with concomitant BNP level measurement. The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the institution's human research committee and all patients gave written informed consent.Patients were divided into 2 groups according to BNP level median (66 pg/mL). All patients presented at least a moderate AS (1.0 ± 0.3 cm 2 ; range: 0.4-1.5 cm 2 ) and preserved LV ejection fraction (69 ± 7%; range: 55-81%). Mean age of the population was 70 ± 13 (range: 31-87) years old and a significant correlation between age and BNP levels was found (r = 0.40; p = 0.001). The distribution of BNP levels was 104 ± 142 pg/mL; median: 66; range: 5-700 pg/mL. Patients in the high BNP level group were significantly older (p b 0.001), more often in atrial fibrillation (p b 0.001) or with hypertension (p = 0.048). There were no other significant differences regarding clinical characteristics. Patients in the high BNP level group had significant higher indexed left atrial area (p = 0.017) and E/e′ ratio (p = 0.001). There was no significant difference in AS severity and LV mass, volumes and function between groups (Table 1). Significant correlations were found between BNP levels and indexed left atrial area (r = 0.346; p = 0.008), E/A ratio (r = 0.344; p = 0.009) and E/e′ ratio (r = 0.584; p b 0.001, Fig. 1b). After adjustment for age, indexed aortic valve area, LV global longitudinal strain and left atrial area, multivariable analysis identified E/e′ (β = 18.2 ± 2.9; p b 0.001) and LV end-diastolic volume (β = −2.1 ± 0.7; p = 0.006) as independent resting predictors of BNP level.Patients in the high BNP level group had significant higher exercise E/e′ ratio (p = 0.018) and lower LV global longitudinal strain (p = 0.020). There was no difference in AS severity, LV stroke volume and ejection fraction between groups (Table 1). Significant correlations were fou...

show abstract

supporting

confidence: 75%

“…Due to these properties, NK cells play significant roles in the control of microbial infections [3]. Several human studies have shown that NK cell activity is depressed in patients with coronary artery disease (CAD) [4,5]. However, the mechanism of NK cell dysfunction in CAD remains unclear.…”

mentioning

confidence: 99%

Brain natriuretic peptide release in patients with aortic stenosis: Resting and exercise echocardiographic determinants

Henri

Magné

Laaraibi

et al. 2014

International Journal of Cardiology

View full text Add to dashboard Cite

show abstract

“…While some authors describe the ability of E/e' to predict LVFP elevation during exercise 2,4 , others did not find any relation between exercise-induced changes in E/e' and PCWP (ref. 10,16 ). There are several possible reasons for these discrepancies.…”

Section: Discussionmentioning

confidence: 99%

Variability of post-exercise pulmonary capillary wedge pressure recovery. Implications for noninvasive echocardiographic diagnostics

Meluzı́n

Hude²,

Krejčí³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

View full text Add to dashboard Cite

Aim. The aim of our study was to assess the course of immediate post-exercise pulmonary capillary wedge pressure (PCWP) changes to identify the optimal time window for the noninvasive diagnostics of exercise-induced PCWP elevation. Methods and Results. Seventy-one patients at risk of heart failure with normal left ventricular ejection fraction underwent simultaneous exercise echocardiography and right heart catheterization. The ratio of early left ventricular filling velocity (E) to early diastolic mitral annular velocity (e') was used to predict noninvasively exercise-induced PCWP elevation. Fifty-one patients had exercise-induced PCWP elevation ≥ 8 mmHg and reached peak exercise PCWP ≥ 20 mmHg. Rapid post-exercise recovery of PCWP within 2 min was achieved in 18 (35.3%) patients. Intermediate postexercise PCWP recovery at 3 and 4 min was found in 16 (31.4%) patients while late post-exercise PCWP recovery (≥ 5 min) was achieved in 17 (33.3%) patients. Conclusion. The course of post-exercise PCWP recovery is highly variable, and a significant proportion of patients have only a brief period (≤ 2 min) of exercise-induced PCWP elevation. This fact should be taken into account in noninvasive assessment of exercise-induced PCWP.

show abstract

“…Cette augmentation des pressions de remplissage liée à la baisse de la compliance VG contribue à la limitation de la capacité à l'exercice et pourrait expliquer la survenue de la dyspnée d'effort chez des patients porteurs de SA sévère [26].…”

Section: Fonction Diastoliqueunclassified

Sténose aortique sévère asymptomatique à fraction d’éjection ventriculaire gauche préservée. Évaluation à l’effort : quels résultats et quelles décisions ?

Bensahi

Elfhal

Magné

et al. 2015

Annales de Cardiologie et d'Angéiologie

View full text Add to dashboard Cite

Left Ventricular Filling Pressure Estimation at Rest and During Exercise in Patients With Severe Aortic Valve Stenosis: Comparison of Echocardiographic and Invasive Measurements

Cited by 67 publications

References 26 publications

Brain natriuretic peptide release in patients with aortic stenosis: Resting and exercise echocardiographic determinants

Brain natriuretic peptide release in patients with aortic stenosis: Resting and exercise echocardiographic determinants

Variability of post-exercise pulmonary capillary wedge pressure recovery. Implications for noninvasive echocardiographic diagnostics

Sténose aortique sévère asymptomatique à fraction d’éjection ventriculaire gauche préservée. Évaluation à l’effort : quels résultats et quelles décisions ?

Contact Info

Product

Resources

About