Effect of the 2017 European Guidelines on Reclassification of Severe Aortic Stenosis and Its Influence on Management Decisions for Initially Asymptomatic Aortic Stenosis

Background: The 2017 European Society of Cardiology guidelines for valvular heart disease included changes in the definition of severe aortic stenosis (AS). We wanted to evaluate its influence on management decisions in asymptomatic patients with moderate-severe AS. Methods: We reclassified the AS severity of the participants of the PRIMID-AS study (Prognostic Importance of Microvascular Dysfunction in Asymptomatic Patients With AS), using the 2017 guidelines, determined their risk of reaching a clinical end point (valve replacement for symptoms, hospitalization, or cardiovascular death) and evaluated the prognostic value of aortic valve calcium score and biomarkers. Patients underwent echocardiography, cardiac magnetic resonance imaging, exercise tolerance testing, and biomarker assessment. Results: Of the 174 participants, 45% (56/124) classified as severe AS were reclassified as moderate AS. This reclassified group was similar to the original moderate group in clinical characteristics, gradients, calcium scores, and remodeling parameters. There were 47 primary end points (41 valve replacement, 1 death, and 5 hospitalizations—1 chest pain, 2 dyspnea, 1 heart failure, and 1 syncope) over 368±156 days follow-up. The severe and reclassified groups had a higher risk compared with moderate group (adjusted hazard ratio 4.95 [2.02–12.13] and 2.78 [1.07–7.22], respectively), with the reclassified group demonstrating an intermediate risk. A mean pressure gradient ≥31 mm Hg had a 7× higher risk of the primary end point in the reclassified group. Aortic valve calcium score was more prognostic in females and low valve area but not after adjusting for gradients. NT-proBNP (N-terminal pro-brain-type natriuretic peptide) and myocardial perfusion reserve were associated with the primary end point but not after adjusting for positive exercise tolerance testing. Troponin was associated with cardiovascular death or unplanned hospitalizations. Conclusions: Reclassification of asymptomatic severe AS into moderate AS was common using the European Society of Cardiology 2017 guidelines. This group had an intermediate risk of reaching the primary end point. Exercise testing, multimodality imaging, and lower mean pressure gradient threshold of 31 mm Hg may improve risk stratification. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01658345.

PO-060 Changes of Cardiovascular Function during Exercise Tolerance Testing in Sedentary Postmenopausal Women after Exercise Intervention

Objective Previous studies suggested that being postmenopausal could increase the risk of cardiovascular disease(CVD). If we can master the change characteristics of postmenopausal women’ cardiovascular function when they doing exercise, we may prevent or reduce the risk of CVD which induced by exercise. To get a more accurate tolerant judgment of the intensity of exercise, we discussed the change of cardiovascular function in sedentary postmenopausal women during exercise tolerance testing after exercise intervention, wish to provide more reliable theory basis in preventing exercise emergence and make an appropriate exercise prescription. Methods Thirty postmenopausal women participated the study. PAR-Q questionnaires and International Physical Activity Questionnaire-Short Forms were used to screen participants. They were randomly divided into control group(n=15) and experimental group (n=15). The experimental group had an exercise intervention with 3 months walking while the control group lived as usual. Using an exercise tolerance testing by cycle ergometer, let participants do one-time maximal graded exercise test to exhaustion, get the indicators of heart rate, blood pressure, VO2max, then analyzed the changes of cardiovascular function indexes before and after exercise intervention in experimental group, compared with control group in the same age categories, explored the similarities and differences between index variation. Results (1) After 3 months of exercise intervention, the rest systolic blood pressure in the experimental group was significantly lower than that in the control group(P<0.05). (2) With the increase of exercise intensity, heart rate tend to rise in both two groups (P<0.05). After 3 months of exercise intervention, the amplitude of heart rate variation between two intensities got smaller in the experimental group. (3) With the enlargement of exercise intensity, systolic blood pressure tend to increase in both two groups (P<0.05). After 3 months of exercise intervention, the amplitude of systolic blood pressure variation between two grades got smaller in the experimental group. (4) The exercise intervention can effectively improve the cardiac functional capacity of postmenopausal women (P<0.05). Conclusions Exercise for 3 month can efficiently increase the ability of postmenopausal women’s cardiovascular system in the quiet state, increase the reaction and adaptability of intensity stimulation of heart.