European Heart Journal - Cardiovascular Imaging最新文献

Aims: Although an association between the systemic circulation and transaortic flow rate (TFR) is frequently hypothesized in patients with aortic stenosis (AS), it has not been demonstrated previously. We sought to explore the relationship between blood pressure (BP), vascular afterload measures, clinical history of hypertension, TFR, and survival in patients with severe AS (aortic valve area ≤ 1 cm²).

Methods and results: We studied 323 patients ≥ 65 years (110 prospective, 213 registry analysis) who underwent transcatheter aortic valve replacement over a 5-year period. Aortic flow was obtained by Doppler echocardiography, with TFR calculated using a mathematical derivation method. A BP ≥ 140/90 mmHg and/or mean arterial pressure ≥ 90 mmHg was considered hypertensive. Simultaneous pressure-flow analysis demonstrated that higher systolic BP (ß -0.545; P = 0.01†), pulse pressure (ß -0.545; P = 0.01†), vascular resistance (ß -0.02; P = 0.041), characteristic impedance (ß -0.27; P = 0.01), and lower arterial compliance (ß 32.73; P < 0.001†) were associated with reduced TFR in linear regression. In registry analysis, TFR was lower in those with a history of hypertension (223 ± 67 vs. 244 ± 77 mL/s; r -0.138; P = 0.045), coronary artery disease (CAD, P < 0.01), dialysis dependency (P < 0.01), and with increased anti-hypertensive medication use (P = 0.04), of which CAD (ß -28.5; P = 0.08†) and dialysis dependency (ß -68.5; P = 0.04†) remained significant in linear regression. A TFR ≤ 210 mL/s in normotensive patients was the strongest predictor of mortality (73.3% vs. 86.7%; P = 0.043; † denotes adjusted).

Conclusion: Elevated vascular afterload measures and comorbidities linked to arteriosclerosis and/or degenerative aortic stiffening independently reduce flow rates in severe AS. A TFR ≤ 210 mL/s predicts mortality but improves with BP assessment during evaluation.

Aims: Left ventricular (LV) diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF) are common cardiac complications of patients with systemic sclerosis (SSc). Exercise stress echocardiography is often used in symptomatic patients with SSc to detect abnormal increases in pulmonary pressures during exercise, but the pathophysiologic and prognostic significance of exercise stress echocardiography to assess the presence of HFpEF in these patients is unclear.

Methods and results: Patients with SSc (n=140) underwent ergometry exercise stress echocardiography with simultaneous expired gas analysis. The HFA-PEFF score ≥ 5 points was used to diagnose HFpEF. Thirty-five patients met the HFpEF criteria (prevalence 25%). Compared to patients with SSc-non-HFpEF, those with SSc-HFpEF were older and had a higher prevalence of coronary artery disease, more severe LV diastolic dysfunction (by definition), depressed right ventricular systolic function, reduced exercise capacity (lower peak oxygen consumption), and poorer ventilatory efficiency. Exercise right heart catheterization (RHC) was performed in 25 patients and it confirmed elevated pulmonary capillary wedge pressure during peak exercise in patients with SSc-HFpEF. Participants were followed up to assess the primary composite endpoint: all-cause mortality, HF hospitalization, unplanned hospital visits requiring intravenous diuretics, or oral diuretic intensification. Compared to SSc-non-HFpEF, SSc-HFpEF had a 5.3-fold increased risk of the composite outcomes (hazard ratio 5.29, confidence intervals 2.06-13.5, p=0.0005).

Conclusion: In addition to pulmonary hemodynamics, exercise stress echocardiography may be useful to identify the HFpEF phenotype that has different pathophysiology and clinical outcomes in patients with SSc.