Relationship between exercise pressure gradient and haemodynamic progression of aortic stenosis

Anne Ringle (1, 2) , Franck Levy (3) , Pierre-Vladimir Ennezat (4) , Caroline Le Goffic (1, 2) , Anne-Laure Castel (2, 1) , Francois Delelis (2, 1) , Aymeric Menet (2, 1) , Dorothee Malaquin (3) , Pierre Graux (2, 1) , Andre Vincentelli (5) , Christophe Tribouilloy (3, 6) , Sylvestre Marechaux (2, 1, 6)

1 GHICL - Groupement des Hôpitaux de l'Institut Catholique de Lille
2 UCL - Université catholique de Lille
3 CHU Amiens-Picardie
4 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
5 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
6 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517

Background and aims. - We hypothesized that large exercise-induced increases in aortic mean pressure gradient can predict haemodynamic progression during follow-up in asymptomatic patients with aortic stenosis. Methods. - We retrospectively identified patients with asymptomatic moderate or severe aortic stenosis (aortic valve area < 1.5 cm(2) or < 1 cm(2)) and normal ejection fraction, who underwent an exercise stress echocardiography at baseline with a normal exercise test and a resting echocardiography during follow-up. The relationship between exercise-induced increase in aortic mean pressure gradient and annualised changes in resting mean pressure gradient during follow-up was investigated. Results. - Fifty-five patients (mean age 66 15 years; 45% severe aortic stenosis) were included. Aortic mean pressure gradient significantly increased from rest to peak exercise (P < 0.001). During a median follow-up of 1.6 [1.1-3.2] years, resting mean pressure gradient increased from 35 +/- 13 mmHg to 48 16 mmHg, P < 0.0001. Median annualised change in resting mean pressure gradient during follow-up was 5 [2-11] mmHg. Exercise-induced increase in aortic mean pressure gradient did correlate with annualised changes in mean pressure gradient during follow-up (r=0.35, P=0.01). Hemodynamic progression of aortic stenosis was faster in patients with large exercise-induced increase in aortic mean pressure gradient (> 20 mmHg) as compared to those with exercise-induced increase in aortic mean pressure gradient < 20 mmHg (median annualised increase in mean pressure gradient 19 [6-28] vs. 4 [2-10] mmHg/y respectively, P=0.002). Similar results were found in the subgroup of 30 patients with moderate aortic stenosis. Conclusion. - Large exercise-induced increases in aortic mean pressure gradient correlate with haemodynamic progression of stenosis during follow-up in patients with asymptomatic aortic stenosis. Further studies are needed to fully establish the role of ESE in the decision-making process in comparison to other prognostic markers in asymptomatic patients with aortic stenosis. (C) 2017 Elsevier Masson SAS. All rights reserved.

Mots clés: Aortic stenosis; Aortic valve; Echocardiography; Exercise; Progression; Rétrécissement aortique; Test d’effort; Valve aortique; Échocardiographie d’effort

Domaines: Sciences du Vivant [q-bio]

Anne Ringle, Franck Levy, Pierre-Vladimir Ennezat, Caroline Le Goffic, Anne-Laure Castel, et al.. Relationship between exercise pressure gradient and haemodynamic progression of aortic stenosis. Archives of cardiovascular diseases, 2017, 110 (8-9), pp.466-474. ⟨10.1016/j.acvd.2016.12.009⟩. ⟨hal-03580703⟩