Clinical InvestigationAortic StenosisNoninvasive Coronary Flow Reserve Predicts Response to Exercise in Asymptomatic Severe Aortic Stenosis
Section snippets
Population
Sixty patients with severe asymptomatic AS (aortic valve area ≤ 1 cm2 or indexed aortic valve area ≤ 0.6 cm2/m2) and preserved LVEF (≥50%) were prospectively enrolled in this two-center study (Compiègne Hospital, Compiègne, France, n = 52; Institut Mutualiste Montsouris, Paris, France, n = 8). Two independent cardiologists blinded to patients’ echocardiographic and biochemical data assessed the absence of symptoms. Patients classified as asymptomatic had to be free of shortness of breath,
Results
The baseline characteristics of patients unable to perform ESE, the ESE group, and each subgroup (normal vs abnormal results on ESE) are summarized in Table 1. Except being older and more frequently women, patients unable to perform ESE had similar characteristics as the ESE group. Coronary flow velocity and hemodynamic measurements at baseline and during adenosine administration are depicted in Table 1 and data related to exercise in Table 2. CFVR was feasible in all patients, with the help of
Discussion
We found in this selective cohort of asymptomatic patients with severe AS and preserved LVEF that noninvasive CFVR was independently correlated with exercise capacity and was associated with abnormal exercise test rsults with good accuracy. Furthermore, the values of CFVR and LAD flow velocity were similar in patients undergoing ESE and those unable to perform ESE because of extracardiac comorbidities.
Conclusions
In patients with asymptomatic severe AS, noninvasive CFVR is independently associated with exercise duration, workload, and abnormal results on ESE with a good accuracy.
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