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Aortic stenosis results in increased filling pressures of the heart. Size and function of the left atrium may be a marker for more advanced heart disease (heart failure) in patients with severe aortic stenosis, not presenting any apparent symptoms.
The goal of this study is to establish the importance and possible implications of left atrial dilation in asymptomatic patients with aortic valve stenosis.
Aortic valve stenosis (AS) is the most common valvular disease in the western world. Mild and moderate AS generally is well tolerated severe AS is associated with considerable morbidity and mortality.
The consequence of AS is increased pressure load on the left ventricle, which causes changes in the ventricular function and structure (Left ventricular remodeling, hypertrophy, fibrosis).
With longstanding elevated filling pressures the left atrium will dilate and heart failure symptoms will develop.
When apparent, symptoms of heart failure, in AS are associated with high mortality rate and aortic valve replacement (AVR) is recommended.
The clinical assessment of heart failure symptoms in AS is however challenging particularly in the elderly, as symptoms progress slowly and may mimic age related fragility.
In this observational study, the goal is to investigate the importance and possible implications of left atrial dilation and heart failure among 100 patients with asymptomatic severe aortic stenosis. Participants undergo echocardiographic evaluation for diastolic heart failure and we assess myocardial fibrosis using magnetic resonance imaging and exercise testing with invasive hemodynamic monitoring (right heart catheterization).
LA dilatation may potentially identify patients likely benefiting of early surgery. The importance and possible implications of LA dilatation in asymptomatic AS patients has however not yet been established.
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| Measure | Description | Time Frame |
|---|---|---|
| Functional Capacity | Differences in functional capacity reflected by atrial size. An incremental maximal exersice test to determine maximal whole-body oxygen uptake (VO2-max) will be performed. On a cycle ergometer VO2 and VCO2 are measured continuously with a breath-by-breath pulmonary exchange system. Following the warm up, the resistance is increased every 2 minutes for 3 bouts, where after the resistance increases every minute (10% increments in VO2-max). The test is terminated 30 seconds after the subjects are unable to maintain 60 revolutions pr. min, but are still able to bike. A horizontal plateau on the oxygen uptake graph demarks the maximal oxygen uptake in liters pr. min. This is divided by their body mass, to obtain maximal oxygen uptake pr. mass unit pr. time unit. | 2 years |
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Inclusion Criteria:
Exclusion Criteria:
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Adult patients with severe asymptomatic aortic stenosis.
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| Name | Affiliation | Role |
|---|---|---|
| Jacob E Møller, MD PhD DMsc | Odense University Hospital | Study Director |
| Jordi S Dahl, MD PhD | Odense University Hospital | Study Chair |
| Lars M Videbæk, MD PhD | Odense University Hospital | Study Chair |
| Eva Søndergaard, MD PhD | Odense University Hospital | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Odense University Hospital | Odense C | 5000 | Denmark |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41730521 | Derived | Ali M, Frederiksen PH, Moller JE, Mogensen NSB, Chemnitz A, Haujir A, Poulsen MK, Ovrehus KA, Pibarot P, Pellikka PA, Clavel MA, Dahl JS. Invasive Hemodynamic Exercise Response in Hemodynamically Significant Aortic Stenosis With Preserved Left Ventricular Ejection Fraction. Circ Heart Fail. 2026 Apr;19(4):e012809. doi: 10.1161/CIRCHEARTFAILURE.125.012809. Epub 2026 Feb 23. | |
| 36356959 |
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| ID | Term |
|---|---|
| D001024 | Aortic Valve Stenosis |
| D006333 | Heart Failure |
| D009202 | Cardiomyopathies |
| D004719 | Endomyocardial Fibrosis |
| D002318 | Cardiovascular Diseases |
| D006331 | Heart Diseases |
| D006349 | Heart Valve Diseases |
| D001281 | Atrial Fibrillation |
| D006984 | Hypertrophy |
| D017379 | Hypertrophy, Left Ventricular |
| ID | Term |
|---|---|
| D000082862 | Aortic Valve Disease |
| D014694 | Ventricular Outflow Obstruction |
| D001145 | Arrhythmias, Cardiac |
| D010335 | Pathologic Processes |
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Blood
| Derived |
| Andersen MJ, Wolsk E, Bakkestrom R, Christensen N, Carter-Storch R, Omar M, Dahl JS, Frederiksen PH, Borlaug B, Gustafsson F, Hassager C, Moller JE. Pressure-flow responses to exercise in aortic stenosis, mitral regurgitation and diastolic dysfunction. Heart. 2022 Nov 10;108(23):1895-1903. doi: 10.1136/heartjnl-2022-321204. |
| 33574022 | Derived | Carter-Storch R, Mortensen NSB, Christensen NL, Ali M, Laursen KB, Pellikka PA, Moller JE, Dahl JS. First-phase ejection fraction: association with remodelling and outcome in aortic valve stenosis. Open Heart. 2021 Feb;8(1):e001543. doi: 10.1136/openhrt-2020-001543. |
| 27894069 | Derived | Christensen NL, Dahl JS, Carter-Storch R, Bakkestrom R, Jensen K, Steffensen FH, Sondergaard EV, Videbaek L, Moller JE. Association Between Left Atrial Dilatation and Invasive Hemodynamics at Rest and During Exercise in Asymptomatic Aortic Stenosis. Circ Cardiovasc Imaging. 2016 Oct;9(10):e005156. doi: 10.1161/CIRCIMAGING.116.005156. |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D020763 | Pathological Conditions, Anatomical |
| D006332 | Cardiomegaly |