Association between left ventricular diastolic function and right ventricular function and morphology in asymptomatic aortic stenosis
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. A total of 41 patient...
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| creator | 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 |
| description | 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.
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).
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. |
| doi_str_mv | 10.1371/journal.pone.0215364 |
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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).
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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0215364</identifier><identifier>PMID: 31361748</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Aged, 80 and over ; Aorta ; Aortic stenosis ; Aortic valve stenosis ; Aortic Valve Stenosis - pathology ; Aortic Valve Stenosis - physiopathology ; Biology and Life Sciences ; Cardiac patients ; Cardiology ; Catheterization ; Consent ; Development and progression ; Diagnostic imaging ; Diastole ; Echocardiography ; Electrocardiography ; Female ; Gadoterate meglumine ; Heart ; Heart catheterization ; Heart failure ; Heart Ventricles - pathology ; Heart Ventricles - physiopathology ; Hemodynamics ; Humans ; Hypertension ; Magnetic resonance ; Magnetic resonance imaging ; Male ; Medical research ; Medicine and Health Sciences ; Middle Aged ; Morphology ; NMR ; Nuclear magnetic resonance ; Oxygen ; Oxygen Consumption ; Pressure ; Pulmonary arteries ; Pulmonary artery ; Research and Analysis Methods ; Rest ; Stenosis ; Stroke Volume ; Studies ; Velocity ; Ventricle ; Ventricular Dysfunction - pathology ; Ventricular Dysfunction - physiopathology ; Ventricular Dysfunction, Left ; Ventricular Dysfunction, Right ; Ventricular function ; Ventricular Function, Left</subject><ispartof>PloS one, 2019-07, Vol.14 (7), p.e0215364-e0215364</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Christensen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Christensen et al 2019 Christensen et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-cf2f73e6a17199840e1f5dfad383e821228a92bb08232d0ffbcb5a6ed54036543</citedby><cites>FETCH-LOGICAL-c692t-cf2f73e6a17199840e1f5dfad383e821228a92bb08232d0ffbcb5a6ed54036543</cites><orcidid>0000-0002-4895-0588 ; 0000-0002-0359-8728 ; 0000-0003-0252-6631 ; 0000-0003-2873-5845</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667115/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667115/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23847,27903,27904,53769,53771,79346,79347</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31361748$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Lahm, Tim</contributor><creatorcontrib>Christensen, Nicolaj Lyhne</creatorcontrib><creatorcontrib>Dahl, Jordi Sanchez</creatorcontrib><creatorcontrib>Carter-Storch, Rasmus</creatorcontrib><creatorcontrib>Jensen, Kurt</creatorcontrib><creatorcontrib>Pecini, Redi</creatorcontrib><creatorcontrib>Steffensen, Flemming Hald</creatorcontrib><creatorcontrib>Søndergaard, Eva Vad</creatorcontrib><creatorcontrib>Videbæk, Lars Melgaard</creatorcontrib><creatorcontrib>Møller, Jacob Eifer</creatorcontrib><title>Association between left ventricular diastolic function and right ventricular function and morphology in asymptomatic aortic stenosis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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.
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).
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.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aorta</subject><subject>Aortic stenosis</subject><subject>Aortic valve stenosis</subject><subject>Aortic Valve Stenosis - pathology</subject><subject>Aortic Valve Stenosis - physiopathology</subject><subject>Biology and Life Sciences</subject><subject>Cardiac patients</subject><subject>Cardiology</subject><subject>Catheterization</subject><subject>Consent</subject><subject>Development and progression</subject><subject>Diagnostic imaging</subject><subject>Diastole</subject><subject>Echocardiography</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Gadoterate meglumine</subject><subject>Heart</subject><subject>Heart catheterization</subject><subject>Heart failure</subject><subject>Heart Ventricles - pathology</subject><subject>Heart Ventricles - physiopathology</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Magnetic resonance</subject><subject>Magnetic resonance imaging</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Morphology</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>Oxygen</subject><subject>Oxygen Consumption</subject><subject>Pressure</subject><subject>Pulmonary arteries</subject><subject>Pulmonary artery</subject><subject>Research and Analysis Methods</subject><subject>Rest</subject><subject>Stenosis</subject><subject>Stroke Volume</subject><subject>Studies</subject><subject>Velocity</subject><subject>Ventricle</subject><subject>Ventricular Dysfunction - pathology</subject><subject>Ventricular Dysfunction - physiopathology</subject><subject>Ventricular Dysfunction, Left</subject><subject>Ventricular Dysfunction, Right</subject><subject>Ventricular function</subject><subject>Ventricular Function, 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between left ventricular diastolic function and right ventricular function and morphology in asymptomatic aortic stenosis</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-cf2f73e6a17199840e1f5dfad383e821228a92bb08232d0ffbcb5a6ed54036543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aorta</topic><topic>Aortic stenosis</topic><topic>Aortic valve stenosis</topic><topic>Aortic Valve Stenosis - pathology</topic><topic>Aortic Valve Stenosis - physiopathology</topic><topic>Biology and Life Sciences</topic><topic>Cardiac 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Analysis Methods</topic><topic>Rest</topic><topic>Stenosis</topic><topic>Stroke Volume</topic><topic>Studies</topic><topic>Velocity</topic><topic>Ventricle</topic><topic>Ventricular Dysfunction - pathology</topic><topic>Ventricular Dysfunction - physiopathology</topic><topic>Ventricular Dysfunction, Left</topic><topic>Ventricular Dysfunction, Right</topic><topic>Ventricular function</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Christensen, Nicolaj Lyhne</creatorcontrib><creatorcontrib>Dahl, Jordi Sanchez</creatorcontrib><creatorcontrib>Carter-Storch, Rasmus</creatorcontrib><creatorcontrib>Jensen, Kurt</creatorcontrib><creatorcontrib>Pecini, Redi</creatorcontrib><creatorcontrib>Steffensen, Flemming Hald</creatorcontrib><creatorcontrib>Søndergaard, Eva Vad</creatorcontrib><creatorcontrib>Videbæk, Lars Melgaard</creatorcontrib><creatorcontrib>Møller, Jacob 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Hald</au><au>Søndergaard, Eva Vad</au><au>Videbæk, Lars Melgaard</au><au>Møller, Jacob Eifer</au><au>Lahm, Tim</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association between left ventricular diastolic function and right ventricular function and morphology in asymptomatic aortic stenosis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-07-30</date><risdate>2019</risdate><volume>14</volume><issue>7</issue><spage>e0215364</spage><epage>e0215364</epage><pages>e0215364-e0215364</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.
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).
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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31361748</pmid><doi>10.1371/journal.pone.0215364</doi><tpages>e0215364</tpages><orcidid>https://orcid.org/0000-0002-4895-0588</orcidid><orcidid>https://orcid.org/0000-0002-0359-8728</orcidid><orcidid>https://orcid.org/0000-0003-0252-6631</orcidid><orcidid>https://orcid.org/0000-0003-2873-5845</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2019-07, Vol.14 (7), p.e0215364-e0215364 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2267002483 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Aged Aged, 80 and over Aorta Aortic stenosis Aortic valve stenosis Aortic Valve Stenosis - pathology Aortic Valve Stenosis - physiopathology Biology and Life Sciences Cardiac patients Cardiology Catheterization Consent Development and progression Diagnostic imaging Diastole Echocardiography Electrocardiography Female Gadoterate meglumine Heart Heart catheterization Heart failure Heart Ventricles - pathology Heart Ventricles - physiopathology Hemodynamics Humans Hypertension Magnetic resonance Magnetic resonance imaging Male Medical research Medicine and Health Sciences Middle Aged Morphology NMR Nuclear magnetic resonance Oxygen Oxygen Consumption Pressure Pulmonary arteries Pulmonary artery Research and Analysis Methods Rest Stenosis Stroke Volume Studies Velocity Ventricle Ventricular Dysfunction - pathology Ventricular Dysfunction - physiopathology Ventricular Dysfunction, Left Ventricular Dysfunction, Right Ventricular function Ventricular Function, Left |
| title | Association between left ventricular diastolic function and right ventricular function and morphology in asymptomatic aortic stenosis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-27T17%3A07%3A39IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Association%20between%20left%20ventricular%20diastolic%20function%20and%20right%20ventricular%20function%20and%20morphology%20in%20asymptomatic%20aortic%20stenosis&rft.jtitle=PloS%20one&rft.au=Christensen,%20Nicolaj%20Lyhne&rft.date=2019-07-30&rft.volume=14&rft.issue=7&rft.spage=e0215364&rft.epage=e0215364&rft.pages=e0215364-e0215364&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0215364&rft_dat=%3Cgale_plos_%3EA594981737%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2267002483&rft_id=info:pmid/31361748&rft_galeid=A594981737&rft_doaj_id=oai_doaj_org_article_0bc0eb419de644de89a9aec9222e7606&rfr_iscdi=true |