{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T23:53:44Z","timestamp":1787615624540,"version":"build-2736575974"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,10,24]],"date-time":"2023-10-24T00:00:00Z","timestamp":1698105600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To study the impact of heart failure with preserved ejection fraction (HFpEF) vs. aortic stenosis (AS) lesion severity on left ventricular (LV) hypertrophy, diastolic dysfunction, left atrial (LA) dysfunction, haemodynamics, and exercise capacity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Patients (n = 206) with at least moderate AS (aortic valve area \u22640.85\u2005cm\/m2) and discordant symptoms underwent cardiopulmonary exercise testing with simultaneous echocardiography. The population was stratified according to the probability of underlying HFpEF by the heavy, hypertension, atrial fibrillation, pulmonary hypertension, elder, filling pressure (H2FPEF) score [0\u20135 (AS\/HFpEF\u2212) vs. 6\u20139 points (AS\/HFpEF+)] and AS severity (Moderate vs. Severe). Mean age was 73 \u00b1 10 years with 40% women. Twenty-eight patients had Severe AS\/HFpEF+ (14%), 111 Severe AS\/HFpEF\u2212 (54%), 13 Moderate AS\/HFpEF+ (6%), and 54 Moderate AS\/HFpEF\u2212 (26%). AS\/HFpEF+ vs. AS\/HFpEF\u2212 patients, irrespective of AS severity, had a lower LV global longitudinal strain, impaired diastolic function, reduced LV compliance, and more pronounced LA dysfunction. The pulmonary arterial pressure\u2013cardiac output slope was significantly higher in AS\/HFpEF+ vs. AS\/HFpEF\u2212 (5.4 \u00b1 3.1 vs. 3.9 \u00b1 2.2\u2005mmHg\/L\/min, respectively; P = 0.003), mainly driven by impaired cardiac output and chronotropic reserve, with signs of right ventricular pulmonary arterial uncoupling. AS\/HFpEF+ vs. AS\/HFpEF\u2212 was associated with a lower peak aerobic capacity (11.5 \u00b1 3.7 vs. 15.9 \u00b1 5.9\u2005mL\/min\/kg, respectively; P &amp;lt; 0.0001) but did not differ between Moderate and Severe AS (14.7 \u00b1 5.5 vs. 15.2 \u00b1 5.9\u2005mL\/min\/kg, respectively; P = 0.6).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A high H2FPEF score is associated with a reduced exercise capacity and adverse haemodynamics in patients with moderate to severe AS. Both exercise performance and haemodynamics correspond better with intrinsic cardiac dysfunction than AS severity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jead276","type":"journal-article","created":{"date-parts":[[2023,10,24]],"date-time":"2023-10-24T18:37:21Z","timestamp":1698172641000},"page":"302-312","source":"Crossref","is-referenced-by-count":19,"title":["Cardiac dysfunction rather than aortic valve stenosis severity drives exercise intolerance and adverse haemodynamics"],"prefix":"10.1093","volume":"25","author":[{"given":"Sarah","family":"Hoedemakers","sequence":"first","affiliation":[{"name":"Department of Cardiology, Jessa Hospital , Hasselt , Belgium"},{"name":"Biomedical Research Institute, Faculty of Medicine and Life Sciences, University Hasselt (UHasselt) , Hasselt , Belgium"},{"name":"Centre for Cardiovascular Diseases, University Hospital Brussels , Laarbeeklaan 101, 1090 Jette, 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