{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:01:04Z","timestamp":1782363664912,"version":"3.54.5"},"reference-count":23,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/100007405","name":"Hjerteforeningen","doi-asserted-by":"publisher","award":["13-04-R94-A4520-22801"],"award-info":[{"award-number":["13-04-R94-A4520-22801"]}],"id":[{"id":"10.13039\/100007405","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008392","name":"Sundhed og Sygdom, Det Frie Forskningsr\u00e5d","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008392","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Heede Nielsen fonden"},{"DOI":"10.13039\/501100003035","name":"Aase og Ejnar Danielsens Fond","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003035","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009910","name":"Hartmann fonden","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009910","id-type":"DOI","asserted-by":"crossref"}]},{"name":"OPEN biobank fonden"},{"name":"Overl\u00e6ger\u00e5dets fonde"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2019,3,4]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>In aortic stenosis (AS), there is poor association between symptoms and conventional markers of AS severity or left ventricular (LV) systolic function. This may reflect that symptoms arise from LV diastolic dysfunction or that aortic valve area (AVA) and transvalvular gradient do not reflect afterload. We aimed to study the impact of afterload (end-systolic wall stress [ESWS]) on the presence of symptoms in AS and to test whether symptoms are related to increased ESWS or LV remodelling.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>In a prospective study, ESWS was estimated by measuring LV wall thickness from MRI and estimated LV end systolic pressure from echocardiographic mean gradient and systolic blood pressure in 78 patients with severe AS scheduled for aortic valve replacement and 91 patients with asymptomatic severe AS. Symptomatic patients had lower indexed AVA (0.40\u00b10.11 vs 0.45\u00b10.09\u2009cm<jats:sup>2<\/jats:sup>\/m<jats:sup>2<\/jats:sup>, p=0.009). They had undergone more extensive remodelling (MRI LV mass index [LVMi]: 85\u00b124 vs 69\u00b117\u2009g\/m<jats:sup>2<\/jats:sup>, p&lt;0.0001), had higher tricuspid regurgitant gradient (24\u00b18\u2009mm Hg vs 19 \u00b1 7\u2009mm Hg, p=0.0001) and poorer global longitudinal strain (\u221215.6\u00b13.8\u2009vs \u221219.9\u00b13.2%, p&lt;0.0001). ESWS was higher among symptomatic patients (96\u00b151 vs 76\u00b125 kdynes\/cm<jats:sup>2<\/jats:sup>, p=0.003). Multivariate logistic regression identified echocardiographic relative wall thickness, tricuspid gradient, mitral deceleration time, early diastolic strain rate, MRI LVMi, MRI LV end-diastolic volume index and ESWS as independently associated with being symptomatic.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>ESWS can be estimated from multimodality imaging combining MRI and echocardiography. It is correlated with LV remodelling and neurohormonal activation and is independently associated with symptomatic status in AS.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2019-001021","type":"journal-article","created":{"date-parts":[[2019,4,9]],"date-time":"2019-04-09T10:57:56Z","timestamp":1554807476000},"page":"e001021","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["End-systolic wall stress in aortic stenosis: comparing symptomatic and asymptomatic patients"],"prefix":"10.1136","volume":"6","clinical-trial-number":[{"clinical-trial-number":"nct02395107","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02316587","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0359-8728","authenticated-orcid":false,"given":"Rasmus","family":"Carter-Storch","sequence":"first","affiliation":[{"name":"Cardiology, Odense University Hospital, Odense, Denmark"},{"name":"OPEN, OPEN Odense Patient Data Explorative Network, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob Eifer","family":"Moller","sequence":"additional","affiliation":[{"name":"Cardiology, Odense University Hospital, Odense, Denmark"},{"name":"OPEN, OPEN Odense Patient Data Explorative Network, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4895-0588","authenticated-orcid":false,"given":"Nicolaj Lyhne","family":"Christensen","sequence":"additional","affiliation":[{"name":"Cardiology, Odense University Hospital, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars Melholt","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Redi","family":"Pecini","sequence":"additional","affiliation":[{"name":"Cardiology, Odense University Hospital, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"S\u00f8nderg\u00e5rd","sequence":"additional","affiliation":[{"name":"Cardiology, Odense University Hospital, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars Melgaard","family":"Videb\u00e6k","sequence":"additional","affiliation":[{"name":"Cardiology, Odense University Hospital, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi Sanchez","family":"Dahl","sequence":"additional","affiliation":[{"name":"Cardiology, Odense University Hospital, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,4,9]]},"reference":[{"key":"2025081711104593000_6.1.e001021.1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00877866"},{"key":"2025081711104593000_6.1.e001021.2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.62.1.42"},{"key":"2025081711104593000_6.1.e001021.3","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(89)90496-7"},{"key":"2025081711104593000_6.1.e001021.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.04.079"},{"key":"2025081711104593000_6.1.e001021.5","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jev014"},{"key":"2025081711104593000_6.1.e001021.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2008.11.023"},{"key":"2025081711104593000_6.1.e001021.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2008.01.037"},{"key":"2025081711104593000_6.1.e001021.8","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jew082"},{"key":"2025081711104593000_6.1.e001021.9","doi-asserted-by":"crossref","unstructured":"Schulz-Menger J , Bluemke DA , Bremerich J , et al . Standardized image interpretation and post processing in cardiovascular magnetic resonance: Society for cardiovascular magnetic resonance (SCMR) Board of trustees Task Force on standardized post processing. J Cardiovasc Magn Reson 2013;15.doi:10.1186\/1532-429X-15-35","DOI":"10.1186\/1532-429X-15-35"},{"key":"2025081711104593000_6.1.e001021.10","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.7.765"},{"key":"2025081711104593000_6.1.e001021.11","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.65.1.99"},{"key":"2025081711104593000_6.1.e001021.12","doi-asserted-by":"publisher","DOI":"10.1172\/JCI108079"},{"key":"2025081711104593000_6.1.e001021.13","doi-asserted-by":"publisher","DOI":"10.1007\/BF01906378"},{"key":"2025081711104593000_6.1.e001021.14","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.55.6.575"},{"key":"2025081711104593000_6.1.e001021.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ddmec.2007.12.006"},{"key":"2025081711104593000_6.1.e001021.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2015.03.007"},{"key":"2025081711104593000_6.1.e001021.17","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.847772"},{"key":"2025081711104593000_6.1.e001021.18","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(97)70225-4"},{"key":"2025081711104593000_6.1.e001021.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2009.09.043"},{"key":"2025081711104593000_6.1.e001021.20","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.113.000636"},{"key":"2025081711104593000_6.1.e001021.21","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2010.192997"},{"key":"2025081711104593000_6.1.e001021.22","doi-asserted-by":"crossref","unstructured":"Treibel TA , Fontana M , Gilbertson JA , et al . Occult transthyretin cardiac amyloid in severe calcific aortic stenosis: prevalence and prognosis in patients undergoing surgical aortic valve replacement. Circ Cardiovasc Imaging 2016;9.","DOI":"10.1161\/CIRCIMAGING.116.005066"},{"key":"2025081711104593000_6.1.e001021.23","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr084"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2019-001021","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T18:10:52Z","timestamp":1755454252000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2019-001021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,4,9]]},"published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1136\/openhrt-2019-001021"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2019-001021","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4]]}}}