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Role of Exercise Testing and Speckle Tracking Echocardiography in Paradoxical Severe Aortic Stenosis

Authors
  • Lacalzada-Almeida, Juan1
  • Izquierdo-Gómez, María Manuela1
  • Laynez-Cerdeña, Ignacio1
  • Duque-González, Amelia1
  • Pérez de Isla, Leopoldo2
  • Baeza-Garzón, Flor1
  • Jiménez Sosa, Alejandro3
  • Marí-López, Belén1
  • 1 Cardiology Department, Hospital Universitario de Canarias, Tenerife, ESP
  • 2 Cardiology Department, Hospital Clinico de San Carlos, Madrid, ESP
  • 3 Department of Research, Hospital Universitario de Canarias, Tenerife, ESP
Type
Published Article
Journal
Cureus
Publisher
Cureus, Inc.
Publication Date
Sep 25, 2021
Volume
13
Issue
9
Identifiers
DOI: 10.7759/cureus.18266
PMID: 34595083
PMCID: PMC8474972
Source
PubMed Central
Keywords
Disciplines
  • Cardiology
License
Unknown
External links

Abstract

Introduction The clinical behavior and prognosis of patients with asymptomatic paradoxical low-gradient aortic stenosis (PLGAS) still remain controversial. Some authors consider PLGAS as an echocardiographically poorly quantified moderate AS (MAS). We aimed to investigate the clinical behavior of PLGAS by comparing it with that of asymptomatic high-gradient aortic stenosis (HG-AS) and MAS using transthoracic echocardiography (TTE) with speckle tracking imaging (STI) and cardiopulmonary exercise testing (CPET). The hypothesis of our study is, unlike that described by other authors, to demonstrate the existence of clinical and echocardiographic differences between PLGAS and MAS. Methods A cohort of 113 patients was included and categorized into three groups according to AS type: MAS (n=63), HG-AS (n=29), and PLGAS (n=21). Patients’ clinical data were obtained. Patients underwent 2D TTE with STI and CPET. Results There were no significant differences in the clinical variables between the three AS groups. In the multivariate multinomial logistic regression analysis, with PLGAS being the reference category, the most powerful variable for establishing a difference with HG-AS was the left ventricular mass (LVM) indexed by body-surface area (odds ratio [OR]=1.04, confidence interval (CI)=1.01-1.06, p<0.05). The MAS group showed less abnormal CPET (OR=0.198, CI=0.06-0.69, p<0.05), and higher left ventricle global longitudinal strain rate (GLSR) (OR=0.003, CI=0.00-0.35, p<0.05) than the PLGAS group. Conclusions TTE with STI and CPET established the clear differences between patients with asymptomatic PLGAS and those with asymptomatic MAS, as well as the similarities between patients with PLGAS and those with HG-AS. Our data identify PLGAS as a completely different entity from MAS.

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