Myocardial Oxygen Consumption and Efficiency in Aortic Valve Stenosis Patients With and Without Heart Failure

• Published in: Journal of the American Heart Association Vol. 6; no. 2
• Main Authors: Hansson, Nils Henrik Stubkjær, Sörensen, Jens, Harms, Hendrik Johannes, Kim, Won Yong, Nielsen, Roni, Tolbod, Lars P., Frøkiær, Jørgen, Bouchelouche, Kirsten, Dodt, Karen Kaae, Sihm, Inger, Poulsen, Steen Hvitfeldt, Wiggers, Henrik
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 06.02.2017; Wiley
• Subjects: Aged; aortic valve stenosis; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - metabolism; Disease Progression; Echocardiography; Female; Heart Failure - etiology; Heart Failure - metabolism; Heart Failure - physiopathology; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Magnetic Resonance Imaging, Cine; Male; Middle Aged; myocardial external efficiency; myocardial metabolism; myocardial oxygen consumption; Myocardium - metabolism; Original Research; Oxygen Consumption; Positron-Emission Tomography; Prognosis; Severity of Illness Index; Stroke Volume - physiology; Ventricular Function, Left; aortic valve stenosis; myocardial metabolism; myocardial oxygen consumption; positron emission tomography; myocardial external efficiency
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.116.004810

Background Myocardial oxygen consumption (MVO2) and its coupling to contractile work are fundamentals of cardiac function and may be involved causally in the transition from compensated left ventricular hypertrophy to failure. Nevertheless, these processes have not been studied previously in patients with aortic valve stenosis (AS). Methods and Results Participants underwent 11C‐acetate positron emission tomography, cardiovascular magnetic resonance, and echocardiography to measure MVO2 and myocardial external efficiency (MEE) defined as the ratio of left ventricular stroke work and the energy equivalent of MVO2. We studied 10 healthy controls (group A), 37 asymptomatic AS patients with left ventricular ejection fraction ≥50% (group B), 12 symptomatic AS patients with left ventricular ejection fraction ≥50% (group C), and 9 symptomatic AS patients with left ventricular ejection fraction <50% (group D). MVO2 did not differ among groups A, B, C, and D (0.105±0.02, 0.117±0.024, 0.129±0.032, and 0.104±0.026 mL/min per gram, respectively; P=0.07), whereas MEE was reduced in group D (21.0±1.6%, 22.3±3.3%, 22.1±4.2%, and 17.3±4.7%, respectively; P<0.05). Similarly, patients with global longitudinal strain greater than −12% and paradoxical low‐flow, low‐gradient AS had impaired MEE (P<0.05 versus controls). The ability to discriminate between symptomatic and asymptomatic patients was superior for global longitudinal strain compared with MVO2 and MEE (area under the curve 0.98, 0.48, and 0.61, respectively; P<0.05). Conclusions AS patients display a persistent ability to maintain normal MVO2 and MEE (ie, the ability to convert energy into stroke work); however, patients with left ventricular ejection fraction <50%; global longitudinal strain greater than −12%; or paradoxical low‐flow, low‐gradient AS demonstrate reduced MEE. These findings suggest that mitochondrial uncoupling contributes to the dismal prognosis in patients with reduced contractile function or paradoxical low‐flow, low‐gradient AS.