Association between left ventricular diastolic function and right ventricular function and morphology in asymptomatic aortic stenosis

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

*Corresponding author for this work

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Abstract

Background Aortic stenosis (AS) is a progressive disease in which left ventricular (LV) diastolic dysfunction is common. However, the association between diastolic dysfunction and right ventricular (RV) loading conditions and function has not been investigated in asymptomatic AS patients. Methods and findings A total of 41 patients underwent right heart catheterization and simultaneous echocardiography at rest and during maximal supine exercise, stratified according to resting diastolic function. Cardiac chamber size and morphology was assessed using cardiac magnetic resonance imaging (cMRI). RV stroke work index, pulmonary artery (PA) compliance, PA elastance, PA pulsatility index, and right atrial pressure (RAP) were calculated at rest and maximal exercise. Ten patients (24%) had normal LV filling pattern, 20 patients (49%) had grade 1, and 11 patients (27%) had grade 2 diastolic dysfunction. Compared to patients with normal diastolic filling pattern, patients with diastolic dysfunction had lower RV end-diastolic volume (66 ± 11 ml/m2 vs. 79 ± 15 ml/m2, p = 0.02) and end-systolic volume (25 ± 7 ml/m2 vs. 32 ± 9 ml/m2, p = 0.04). An increase in mean RAP to 15 mmHg following exercise was not seen in patients with normal LV filling, compared to 4 patients (20%) with mild and 7 patients (63%) with moderate diastolic dysfunction (p = 0.003). PA pressure and PA elastance was increased in grade 2 diastolic dysfunction and correlated with RV volume and maximal oxygen consumption (r = -0.71, p < 0.001). Conclusions Moderate diastolic dysfunction is associated with increased RV afterload (elastance), which is compensated at rest, but is associated with increased RAP and inversely related to maximal oxygen consumption during maximal exercise.

Original languageEnglish
Article numbere0215364
JournalPLOS ONE
Volume14
Issue number7
Number of pages11
ISSN1932-6203
DOIs
Publication statusPublished - 30. Jul 2019

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Right Ventricular Function
Left Ventricular Function
pulmonary artery
Pulmonary Artery
Atrial Pressure
Oxygen
Echocardiography
exercise
Exercise
Magnetic resonance
Oxygen Consumption
oxygen consumption
Imaging techniques
Right Ventricular Dysfunction
Lung Compliance
Patient Rights
echocardiography
stroke
magnetic resonance imaging
catheters

Cite this

@article{945cbbb39bb84326b848d92127a640d3,
title = "Association between left ventricular diastolic function and right ventricular function and morphology in asymptomatic aortic stenosis",
abstract = "Background Aortic stenosis (AS) is a progressive disease in which left ventricular (LV) diastolic dysfunction is common. However, the association between diastolic dysfunction and right ventricular (RV) loading conditions and function has not been investigated in asymptomatic AS patients. Methods and findings A total of 41 patients underwent right heart catheterization and simultaneous echocardiography at rest and during maximal supine exercise, stratified according to resting diastolic function. Cardiac chamber size and morphology was assessed using cardiac magnetic resonance imaging (cMRI). RV stroke work index, pulmonary artery (PA) compliance, PA elastance, PA pulsatility index, and right atrial pressure (RAP) were calculated at rest and maximal exercise. Ten patients (24{\%}) had normal LV filling pattern, 20 patients (49{\%}) had grade 1, and 11 patients (27{\%}) had grade 2 diastolic dysfunction. Compared to patients with normal diastolic filling pattern, patients with diastolic dysfunction had lower RV end-diastolic volume (66 ± 11 ml/m2 vs. 79 ± 15 ml/m2, p = 0.02) and end-systolic volume (25 ± 7 ml/m2 vs. 32 ± 9 ml/m2, p = 0.04). An increase in mean RAP to 15 mmHg following exercise was not seen in patients with normal LV filling, compared to 4 patients (20{\%}) with mild and 7 patients (63{\%}) with moderate diastolic dysfunction (p = 0.003). PA pressure and PA elastance was increased in grade 2 diastolic dysfunction and correlated with RV volume and maximal oxygen consumption (r = -0.71, p < 0.001). Conclusions Moderate diastolic dysfunction is associated with increased RV afterload (elastance), which is compensated at rest, but is associated with increased RAP and inversely related to maximal oxygen consumption during maximal exercise.",
author = "Christensen, {Nicolaj Lyhne} and Dahl, {Jordi Sanchez} and Rasmus Carter-Storch and Kurt Jensen and Redi Pecini and Steffensen, {Flemming Hald} and S{\o}ndergaard, {Eva Vad} and Videb{\ae}k, {Lars Melgaard} and M{\o}ller, {Jacob Eifer}",
year = "2019",
month = "7",
day = "30",
doi = "10.1371/journal.pone.0215364",
language = "English",
volume = "14",
journal = "P L o S One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "7",

}

Association between left ventricular diastolic function and right ventricular function and morphology in asymptomatic aortic stenosis. / Christensen, Nicolaj Lyhne; Dahl, Jordi Sanchez; Carter-Storch, Rasmus; Jensen, Kurt; Pecini, Redi; Steffensen, Flemming Hald; Søndergaard, Eva Vad; Videbæk, Lars Melgaard; Møller, Jacob Eifer.

In: PLOS ONE, Vol. 14, No. 7, e0215364, 30.07.2019.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Association between left ventricular diastolic function and right ventricular function and morphology in asymptomatic aortic stenosis

AU - Christensen, Nicolaj Lyhne

AU - Dahl, Jordi Sanchez

AU - Carter-Storch, Rasmus

AU - Jensen, Kurt

AU - Pecini, Redi

AU - Steffensen, Flemming Hald

AU - Søndergaard, Eva Vad

AU - Videbæk, Lars Melgaard

AU - Møller, Jacob Eifer

PY - 2019/7/30

Y1 - 2019/7/30

N2 - Background Aortic stenosis (AS) is a progressive disease in which left ventricular (LV) diastolic dysfunction is common. However, the association between diastolic dysfunction and right ventricular (RV) loading conditions and function has not been investigated in asymptomatic AS patients. Methods and findings A total of 41 patients underwent right heart catheterization and simultaneous echocardiography at rest and during maximal supine exercise, stratified according to resting diastolic function. Cardiac chamber size and morphology was assessed using cardiac magnetic resonance imaging (cMRI). RV stroke work index, pulmonary artery (PA) compliance, PA elastance, PA pulsatility index, and right atrial pressure (RAP) were calculated at rest and maximal exercise. Ten patients (24%) had normal LV filling pattern, 20 patients (49%) had grade 1, and 11 patients (27%) had grade 2 diastolic dysfunction. Compared to patients with normal diastolic filling pattern, patients with diastolic dysfunction had lower RV end-diastolic volume (66 ± 11 ml/m2 vs. 79 ± 15 ml/m2, p = 0.02) and end-systolic volume (25 ± 7 ml/m2 vs. 32 ± 9 ml/m2, p = 0.04). An increase in mean RAP to 15 mmHg following exercise was not seen in patients with normal LV filling, compared to 4 patients (20%) with mild and 7 patients (63%) with moderate diastolic dysfunction (p = 0.003). PA pressure and PA elastance was increased in grade 2 diastolic dysfunction and correlated with RV volume and maximal oxygen consumption (r = -0.71, p < 0.001). Conclusions Moderate diastolic dysfunction is associated with increased RV afterload (elastance), which is compensated at rest, but is associated with increased RAP and inversely related to maximal oxygen consumption during maximal exercise.

AB - Background Aortic stenosis (AS) is a progressive disease in which left ventricular (LV) diastolic dysfunction is common. However, the association between diastolic dysfunction and right ventricular (RV) loading conditions and function has not been investigated in asymptomatic AS patients. Methods and findings A total of 41 patients underwent right heart catheterization and simultaneous echocardiography at rest and during maximal supine exercise, stratified according to resting diastolic function. Cardiac chamber size and morphology was assessed using cardiac magnetic resonance imaging (cMRI). RV stroke work index, pulmonary artery (PA) compliance, PA elastance, PA pulsatility index, and right atrial pressure (RAP) were calculated at rest and maximal exercise. Ten patients (24%) had normal LV filling pattern, 20 patients (49%) had grade 1, and 11 patients (27%) had grade 2 diastolic dysfunction. Compared to patients with normal diastolic filling pattern, patients with diastolic dysfunction had lower RV end-diastolic volume (66 ± 11 ml/m2 vs. 79 ± 15 ml/m2, p = 0.02) and end-systolic volume (25 ± 7 ml/m2 vs. 32 ± 9 ml/m2, p = 0.04). An increase in mean RAP to 15 mmHg following exercise was not seen in patients with normal LV filling, compared to 4 patients (20%) with mild and 7 patients (63%) with moderate diastolic dysfunction (p = 0.003). PA pressure and PA elastance was increased in grade 2 diastolic dysfunction and correlated with RV volume and maximal oxygen consumption (r = -0.71, p < 0.001). Conclusions Moderate diastolic dysfunction is associated with increased RV afterload (elastance), which is compensated at rest, but is associated with increased RAP and inversely related to maximal oxygen consumption during maximal exercise.

U2 - 10.1371/journal.pone.0215364

DO - 10.1371/journal.pone.0215364

M3 - Journal article

VL - 14

JO - P L o S One

JF - P L o S One

SN - 1932-6203

IS - 7

M1 - e0215364

ER -