BACKGROUND:Recent guidelines redefined exercise pulmonary hypertension as a mean pulmonary artery pressure/cardiac output (mPAP/CO) slope >3 mm Hg·L⁻¹·min⁻¹. A peak systolic pulmonary artery pressure >60 mm Hg during exercise has been associated with an increased risk of cardiovascular death, heart failure rehospitalization, and aortic valve replacement in aortic valve stenosis. The prognostic value of the mPAP/CO slope in aortic valve stenosis remains unknown.METHODS:In this prospective cohort study, consecutive patients (n=143; age, 73±11 years) with an aortic valve area ≤1.5 cm² underwent cardiopulmonary exercise testing with echocardiography. They were subsequently evaluated for the occurrence of cardiovascular events (ie, cardiovascular death, heart failure hospitalization, new-onset atrial fibrillation, and aortic valve replacement) during a follow-up period of 1 year. Findings were externally validated (validation cohort, n=141).RESULTS:One cardiovascular death, 32 aortic valve replacements, 9 new-onset atrial fibrillation episodes, and 4 heart failure hospitalizations occurred in the derivation cohort, whereas 5 cardiovascular deaths, 32 aortic valve replacements, 1 new-onset atrial fibrillation episode, and 10 heart failure hospitalizations were observed in the validation cohort. Peak aortic velocity (odds ratio [OR] per SD, 1.48; P=0.036), indexed left atrial volume (OR per SD, 2.15; P=0.001), E/e’ at rest (OR per SD, 1.61; P=0.012), mPAP/CO slope (OR per SD, 2.01; P=0.002), and age-, sex-, and height-based predicted peak exercise oxygen uptake (OR per SD, 0.59; P=0.007) were independently associated with cardiovascular events at 1 year, whereas peak systolic pulmonary artery pressure was not (OR per SD, 1.28; P=0.219). Peak Vo₂ (percent) and mPAP/CO slope provided incremental prognostic value in addition to indexed left atrial volume and aortic valve area (P<0.001). These results were confirmed in the validation cohort.CONCLUSIONS:In moderate and severe aortic valve stenosis, mPAP/CO slope and percent-predicted peak Vo₂ were independent predictors of cardiovascular events, whereas peak systolic pulmonary artery pressure was not. In addition to aortic valve area and indexed left atrial volume, percent-predicted peak Vo₂ and mPAP/CO slope cumulatively improved risk stratification.

中文翻译：

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mPAP/CO 斜率和摄氧量增加了主动脉瓣狭窄的预后价值

背景：最近的指南将运动性肺动脉高压重新定义为平均肺动脉压/心输出量（mPAP/CO）斜率>3 mm Hg·L ^-1 ·min ^-1。运动期间肺动脉收缩压峰值 >60 mm Hg 与心血管死亡、心力衰竭再住院和主动脉瓣狭窄的主动脉瓣置换风险增加相关。 mPAP/CO斜率对主动脉瓣狭窄的预后价值仍不清楚。 方法：在这项前瞻性队列研究中，连续对主动脉瓣面积≤1.5 cm ²的患者（n=143；年龄，73±11岁）进行心肺运动超声心动图检查。随后在一年的随访期间对他们的心血管事件（即心血管死亡、心力衰竭住院、新发心房颤动和主动脉瓣置换术）的发生情况进行了评估。结果经过外部验证（验证队列，n=141）。 结果：衍生队列中发生 1 例心血管死亡、32 例主动脉瓣置换术、9 例新发房颤发作和 4 例心力衰竭住院治疗，而 5 例心血管死亡、32 例主动脉瓣置换术在验证队列中观察到瓣膜置换术、1 例新发房颤发作和 10 例心力衰竭住院治疗。峰值主动脉速度（优势比 [OR] 每 SD，1.48；P = 0.036），索引左心房容积（OR 每 SD，2.15；P = 0.001），静息时 E/e'（OR 每 SD，1.61；P = 0.012）、mPAP/CO 斜率（OR 每 SD，2.01；P = 0.002）以及基于年龄、性别和身高的预测峰值运动摄氧量（OR 每 SD，0.59；P = 0.007）与1 年时发生心血管事件，而肺动脉收缩压峰值则没有发生（OR 每 SD，1.28；P = 0.219）。除了索引左心房容积和主动脉瓣面积之外，峰值 V o _{2 （百分比）和 mPAP/CO 斜率还提供了增量预后价值（} P <0.001）。这些结果在验证队列中得到了证实。结论：在中度和重度主动脉瓣狭窄中，mPAP/CO 斜率和预测峰值 V o ₂百分比是心血管事件的独立预测因子，而肺动脉收缩压峰值则不是。除了主动脉瓣面积和指数左心房容积之外，预测峰值 V o ₂百分比和 mPAP/CO 斜率也逐渐改善了风险分层。