Insights into the mechanism of paradoxical low-flow, low-pressure gradient severe aortic stenosis: association with reduced O2 consumption by the whole body.
Am J Physiol Heart Circ Physiol
; 316(4): H840-H848, 2019 04 01.
Article
em En
| MEDLINE
| ID: mdl-30681367
ABSTRACT
The mechanism of reduced stroke volume index (SVi) in paradoxical low-flow, low-pressure gradient (PLFLPG) aortic stenosis (AS) remains unclarified. Guyton et al. ( 21 ) demonstrated that SVi is determined by whole body O2 consumption (VÌo2) in many subjects, including patients with heart disease. We hypothesized that reduced SVi in PLFLPG AS is associated with reduced VÌo2 by the whole body. This study investigated the relationship between VÌo2, SVi, and AS severity in patients with AS to examine the association between reduced VÌo2 and PLFLPG AS. In 59 patients (24 men and 35 women, mean age 78 ± 7 yr old) with severe AS, SVi, AS severity, and type were evaluated by echocardiography, and VÌo2 was measured by the fraction of O2 in expired gases. SVi and VÌo2 were significantly decreased in 20 patients with PLFLPG AS compared with 39 patients with non-PLFLPG AS (30 ± 4 vs. 41 ± 7 ml/m2 and 2.4 ± 0.5 vs. 3.0 ± 0.5 ml·min-1·kg-1, respectively, P < 0.01). The SVi-to-VÌo2 ratio was not different between the two groups (13.1 ± 2.6 vs. 13.6 ± 2.1, not significant). SVi was independently correlated with VÌo2 ( r = 0.74, P < 0.01) but not with the aortic valve area index. Categorized PLFLPG AS was also significantly associated with reduced VÌo2 ( P < 0.001). PLFLPG AS is associated with reduced VÌo2 by the whole body, which may offer insights into the mechanism of PLFLPG AS. NEW & NOTEWORTHY Paradoxical low-flow, low-pressure gradient severe aortic stenosis (PLFLPG AS) is an important and problematic subtype, and its central pathophysiology with reduced stroke volume is yet to be clarified. We hypothesized and subsequently clarified that reduced stroke volume in PLFLPG AS is associated with reduced O2 consumption by the whole body. This study suggests important insights into the mechanism of PLFLPG AS and may further promote studies to investigate further mechanisms and novel treatment.
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Base de dados:
MEDLINE
Assunto principal:
Estenose da Valva Aórtica
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Consumo de Oxigênio
Tipo de estudo:
Etiology_studies
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Observational_studies
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Risk_factors_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article