Haemodynamic and metabolic phenotyping of patients with aortic stenosis and preserved ejection fraction: A specific phenotype of heart failure with preserved ejection fraction?

ABSTRACT Aims Degenerative aortic valve stenosis with preserved ejection fraction (ASpEF) and heart failure with preserved ejection fraction (HFpEF) display intriguing similarities. This study aimed to provide a non‐invasive, comparative analysis of ASpEF versus HFpEF at rest and during exercise. Methods and results We prospectively enrolled 148 patients with HFpEF and 150 patients with degenerative moderate‐to‐severe ASpEF, together with 66 age‐ and sex‐matched healthy controls. All subjects received a comprehensive evaluation at rest and 351/364 (96%) performed a combined cardiopulmonary exercise stress echocardiography test. Patients with ASpEF eligible for transcatheter aortic valve replacement (n = 125) also performed cardiac computed tomography (CT). HFpEF and ASpEF patients showed similar demographic distribution and biohumoral profiles. Most patients with ASpEF (134/150, 89%) had severe high‐gradient aortic stenosis; 6/150 (4%) had normal‐flow, low‐gradient ASpEF, while 10/150 (7%) had low‐flow, low‐gradient ASpEF. Both patient groups displayed significantly lower peak oxygen consumption (VO2), peak cardiac output, and peak arteriovenous oxygen difference compared to controls (all p