Association Between Left Atrial Dilatation and Invasive Hemodynamics at Rest and During Exercise in Asymptomatic Aortic Stenosis

Nicolaj Lyhne Christensen, Jordi Sanchez Dahl, Rasmus Carter-Storch, Rine Bakkestrøm, Kurt Jensen, Flemming Hald Steffensen, Eva Vad Søndergaard, Lars Videbæk, Jacob Eifer Møller

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND: Transition from an asymptomatic to symptomatic state in severe aortic stenosis is often difficult to assess. Identification of a morphological sign of increased hemodynamic load may be important in asymptomatic aortic stenosis to identify patients at risk.

METHODS AND RESULTS: Thirty-nine patients with asymptomatic severe aortic stenosis (aortic valve area <1 cm(2), peak jet velocity >3.5 m/s) underwent exercise testing with simultaneous invasive hemodynamic monitoring and Doppler echocardiography. Cardiac index, pulmonary artery pressure, and pulmonary capillary wedge pressure (PCWP) were recorded. Patients were followed up for the composite end point of death, unplanned hospitalization, or aortic valve replacement. Patients were stratified into 2 groups according to left atrial (LA) volume index ≥35 mL/m(2). In 25 patients (64%) LA volume index was ≥35 mL/m(2). Aortic valve area was similar between groups (0.81±0.15 versus 0.84±0.18 cm(2); P=0.58). PCWP was higher at rest and during exercise in patients with LA volume index ≥35 mL/m(2) (P<0.01), despite similar cardiac index. At rest, PCWP was <12 mm Hg in 11 patients (44%) with LA dilatation, whereas PCWP was <25 mm Hg in 1 patient (4%) with exercise. LA volume index and E/e' predicted exercise PCWP>30 mm Hg with areas under the receiver operating curve of 0.75 and 0.84, respectively. During follow-up, 14 cardiac events were recorded. LA volume was associated with a hazard ratio of 1.90 (95% confidence interval, 0.92-4.15).

CONCLUSIONS: LA size reflects hemodynamic burden in patients with asymptomatic severe aortic stenosis. Quantitative measurements of LA and diastolic function are associated with left ventricular filling pressures with exercise and could be used to identify asymptomatic patients with increased hemodynamic burden.

CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02395107.

Original languageEnglish
Article numbere005156
JournalCirculation. Cardiovascular Imaging
Volume9
Issue number10
Number of pages10
ISSN1941-9651
DOIs
Publication statusPublished - Oct 2016

Fingerprint

Dilatation
Exercise
Pulmonary Wedge Pressure
Left Atrial Function
Doppler Echocardiography
Ventricular Pressure
Pulmonary Artery
Clinical Trials
Confidence Intervals

Cite this

@article{7fb41a5f6cf54959a5c31cb3b412ee94,
title = "Association Between Left Atrial Dilatation and Invasive Hemodynamics at Rest and During Exercise in Asymptomatic Aortic Stenosis",
abstract = "BACKGROUND: Transition from an asymptomatic to symptomatic state in severe aortic stenosis is often difficult to assess. Identification of a morphological sign of increased hemodynamic load may be important in asymptomatic aortic stenosis to identify patients at risk.METHODS AND RESULTS: Thirty-nine patients with asymptomatic severe aortic stenosis (aortic valve area <1 cm(2), peak jet velocity >3.5 m/s) underwent exercise testing with simultaneous invasive hemodynamic monitoring and Doppler echocardiography. Cardiac index, pulmonary artery pressure, and pulmonary capillary wedge pressure (PCWP) were recorded. Patients were followed up for the composite end point of death, unplanned hospitalization, or aortic valve replacement. Patients were stratified into 2 groups according to left atrial (LA) volume index ≥35 mL/m(2). In 25 patients (64{\%}) LA volume index was ≥35 mL/m(2). Aortic valve area was similar between groups (0.81±0.15 versus 0.84±0.18 cm(2); P=0.58). PCWP was higher at rest and during exercise in patients with LA volume index ≥35 mL/m(2) (P<0.01), despite similar cardiac index. At rest, PCWP was <12 mm Hg in 11 patients (44{\%}) with LA dilatation, whereas PCWP was <25 mm Hg in 1 patient (4{\%}) with exercise. LA volume index and E/e' predicted exercise PCWP>30 mm Hg with areas under the receiver operating curve of 0.75 and 0.84, respectively. During follow-up, 14 cardiac events were recorded. LA volume was associated with a hazard ratio of 1.90 (95{\%} confidence interval, 0.92-4.15).CONCLUSIONS: LA size reflects hemodynamic burden in patients with asymptomatic severe aortic stenosis. Quantitative measurements of LA and diastolic function are associated with left ventricular filling pressures with exercise and could be used to identify asymptomatic patients with increased hemodynamic burden.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02395107.",
author = "Christensen, {Nicolaj Lyhne} and Dahl, {Jordi Sanchez} and Rasmus Carter-Storch and Rine Bakkestr{\o}m and Kurt Jensen and {Hald Steffensen}, Flemming and S{\o}ndergaard, {Eva Vad} and Lars Videb{\ae}k and M{\o}ller, {Jacob Eifer}",
note = "{\circledC} 2016 American Heart Association, Inc.",
year = "2016",
month = "10",
doi = "10.1161/CIRCIMAGING.116.005156",
language = "English",
volume = "9",
journal = "Circulation. Cardiovascular Imaging",
issn = "1941-9651",
publisher = "Lippincott Williams & Wilkins",
number = "10",

}

Association Between Left Atrial Dilatation and Invasive Hemodynamics at Rest and During Exercise in Asymptomatic Aortic Stenosis. / Christensen, Nicolaj Lyhne ; Dahl, Jordi Sanchez; Carter-Storch, Rasmus ; Bakkestrøm, Rine; Jensen, Kurt; Hald Steffensen, Flemming; Søndergaard, Eva Vad; Videbæk, Lars; Møller, Jacob Eifer .

In: Circulation. Cardiovascular Imaging, Vol. 9, No. 10, e005156, 10.2016.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Association Between Left Atrial Dilatation and Invasive Hemodynamics at Rest and During Exercise in Asymptomatic Aortic Stenosis

AU - Christensen, Nicolaj Lyhne

AU - Dahl, Jordi Sanchez

AU - Carter-Storch, Rasmus

AU - Bakkestrøm, Rine

AU - Jensen, Kurt

AU - Hald Steffensen, Flemming

AU - Søndergaard, Eva Vad

AU - Videbæk, Lars

AU - Møller, Jacob Eifer

N1 - © 2016 American Heart Association, Inc.

PY - 2016/10

Y1 - 2016/10

N2 - BACKGROUND: Transition from an asymptomatic to symptomatic state in severe aortic stenosis is often difficult to assess. Identification of a morphological sign of increased hemodynamic load may be important in asymptomatic aortic stenosis to identify patients at risk.METHODS AND RESULTS: Thirty-nine patients with asymptomatic severe aortic stenosis (aortic valve area <1 cm(2), peak jet velocity >3.5 m/s) underwent exercise testing with simultaneous invasive hemodynamic monitoring and Doppler echocardiography. Cardiac index, pulmonary artery pressure, and pulmonary capillary wedge pressure (PCWP) were recorded. Patients were followed up for the composite end point of death, unplanned hospitalization, or aortic valve replacement. Patients were stratified into 2 groups according to left atrial (LA) volume index ≥35 mL/m(2). In 25 patients (64%) LA volume index was ≥35 mL/m(2). Aortic valve area was similar between groups (0.81±0.15 versus 0.84±0.18 cm(2); P=0.58). PCWP was higher at rest and during exercise in patients with LA volume index ≥35 mL/m(2) (P<0.01), despite similar cardiac index. At rest, PCWP was <12 mm Hg in 11 patients (44%) with LA dilatation, whereas PCWP was <25 mm Hg in 1 patient (4%) with exercise. LA volume index and E/e' predicted exercise PCWP>30 mm Hg with areas under the receiver operating curve of 0.75 and 0.84, respectively. During follow-up, 14 cardiac events were recorded. LA volume was associated with a hazard ratio of 1.90 (95% confidence interval, 0.92-4.15).CONCLUSIONS: LA size reflects hemodynamic burden in patients with asymptomatic severe aortic stenosis. Quantitative measurements of LA and diastolic function are associated with left ventricular filling pressures with exercise and could be used to identify asymptomatic patients with increased hemodynamic burden.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02395107.

AB - BACKGROUND: Transition from an asymptomatic to symptomatic state in severe aortic stenosis is often difficult to assess. Identification of a morphological sign of increased hemodynamic load may be important in asymptomatic aortic stenosis to identify patients at risk.METHODS AND RESULTS: Thirty-nine patients with asymptomatic severe aortic stenosis (aortic valve area <1 cm(2), peak jet velocity >3.5 m/s) underwent exercise testing with simultaneous invasive hemodynamic monitoring and Doppler echocardiography. Cardiac index, pulmonary artery pressure, and pulmonary capillary wedge pressure (PCWP) were recorded. Patients were followed up for the composite end point of death, unplanned hospitalization, or aortic valve replacement. Patients were stratified into 2 groups according to left atrial (LA) volume index ≥35 mL/m(2). In 25 patients (64%) LA volume index was ≥35 mL/m(2). Aortic valve area was similar between groups (0.81±0.15 versus 0.84±0.18 cm(2); P=0.58). PCWP was higher at rest and during exercise in patients with LA volume index ≥35 mL/m(2) (P<0.01), despite similar cardiac index. At rest, PCWP was <12 mm Hg in 11 patients (44%) with LA dilatation, whereas PCWP was <25 mm Hg in 1 patient (4%) with exercise. LA volume index and E/e' predicted exercise PCWP>30 mm Hg with areas under the receiver operating curve of 0.75 and 0.84, respectively. During follow-up, 14 cardiac events were recorded. LA volume was associated with a hazard ratio of 1.90 (95% confidence interval, 0.92-4.15).CONCLUSIONS: LA size reflects hemodynamic burden in patients with asymptomatic severe aortic stenosis. Quantitative measurements of LA and diastolic function are associated with left ventricular filling pressures with exercise and could be used to identify asymptomatic patients with increased hemodynamic burden.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02395107.

U2 - 10.1161/CIRCIMAGING.116.005156

DO - 10.1161/CIRCIMAGING.116.005156

M3 - Journal article

C2 - 27894069

VL - 9

JO - Circulation. Cardiovascular Imaging

JF - Circulation. Cardiovascular Imaging

SN - 1941-9651

IS - 10

M1 - e005156

ER -