{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T03:13:06Z","timestamp":1777086786093,"version":"3.51.4"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,8,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">We aimed to investigate the prevalence and prognostic impact of effort intolerance in patients with asymptomatic\/minimally symptomatic aortic stenosis and to study its determinants.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              One hundred four patients with at least moderate asymptomatic\/minimally symptomatic aortic stenosis (median age 79\u2009years, 57% male) underwent 2\u2010dimensional speckle tracking echocardiography and exercise\u2010stress echocardiography with cardiopulmonary exercise test. Results indicated that 73% of patients have effort intolerance defined as %predicted peak V\n              <jats:sub>O2<\/jats:sub>\n              &lt;70%. Left ventricular global longitudinal strain (odds ratio [OR], 3.13, per 3.2% decrease,\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.01), left atrial reservoir strain (OR, 1.91, per 7.9% decrease,\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.01), and right ventricular free wall strain (OR, 2.12, per 5.9% decrease,\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.01) were all associated with effort intolerance. A Strain Index was determined as a sum of points based on receiver operator characteristics analysis: left ventricular global longitudinal strain &gt;17.2%, 15.7% to 17.2%, and &lt;15.7%; left atrial reservoir strain &gt;25.5%, 20.7 to 25.5%, and &lt;20.7%; and right ventricular free wall strain &gt;22.5%, 17.2 to 22.5%, and &lt;17.2%; each variable was associated with 0, 1, and 2 points, respectively. The Strain Index \u22652, the slope of tricuspid annular plane systolic excursion versus systolic pulmonary artery pressure &lt;0.25\u2009mm\/mm\u2009Hg and the slope of mean pulmonary artery pressure versus cardiac output &gt;4.17\u2009mm\u2009Hg\/min per L were also significantly associated with effort intolerance. Significantly higher cardiac death and heart failure\u2010related rehospitalization were observed in the effort\u2010intolerance group.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Both aortic stenosis severity and extra\u2010aortic cardiac injuries lead to effort intolerance. Strain Index and exercise indices such as tricuspid annular plane systolic excursion versus systolic pulmonary artery pressure and mean pulmonary artery pressure versus cardiac output slopes may be valuable for risk stratification in minimally symptomatic\/asymptomatic aortic stenosis.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.125.041414","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T11:49:38Z","timestamp":1753789778000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Prevalence, Mechanisms, and Prognostic Impact of Effort Intolerance in Patients With Asymptomatic\/Minimally Symptomatic Aortic Stenosis"],"prefix":"10.1161","volume":"14","author":[{"given":"Ayano","family":"Hamada","sequence":"first","affiliation":[{"name":"Hiroshima University Graduate School of Biomedical and Health Sciences","place":["Hiroshima, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6587-9584","authenticated-orcid":false,"given":"Hiroto","family":"Utsunomiya","sequence":"additional","affiliation":[{"name":"Hiroshima University Graduate School of Biomedical and Health Sciences","place":["Hiroshima, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1139-1975","authenticated-orcid":false,"given":"Kiyotaka","family":"Tohgi","sequence":"additional","affiliation":[{"name":"Hiroshima University Graduate School of Biomedical and Health Sciences","place":["Hiroshima, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0544-712X","authenticated-orcid":false,"given":"Makoto","family":"Takeuchi","sequence":"additional","affiliation":[{"name":"Hiroshima University Graduate School of Biomedical and Health Sciences","place":["Hiroshima, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4253-2548","authenticated-orcid":false,"given":"Yohei","family":"Hyodo","sequence":"additional","affiliation":[{"name":"Hiroshima University Graduate School of Biomedical and Health Sciences","place":["Hiroshima, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsuo","family":"Mogami","sequence":"additional","affiliation":[{"name":"Hiroshima University Graduate School of Biomedical and Health Sciences","place":["Hiroshima, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8995-4721","authenticated-orcid":false,"given":"Akane","family":"Tsuchiya","sequence":"additional","affiliation":[{"name":"Hiroshima University Graduate School of Biomedical and Health Sciences","place":["Hiroshima, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7887-7940","authenticated-orcid":false,"given":"Kosuke","family":"Takahari","sequence":"additional","affiliation":[{"name":"Hiroshima University Graduate School of Biomedical and Health Sciences","place":["Hiroshima, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuke","family":"Ueda","sequence":"additional","affiliation":[{"name":"Hiroshima University Graduate School of Biomedical and Health Sciences","place":["Hiroshima, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukiko","family":"Nakano","sequence":"additional","affiliation":[{"name":"Hiroshima University Graduate School of Biomedical and Health Sciences","place":["Hiroshima, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69208-8"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000932"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab395"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.shj.2023.100201"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.104.495903"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2006.07.043"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.10.001"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.117.007282"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-021-04630-7"},{"key":"e_1_3_2_11_2","first-page":"1514","article-title":"Standard levels of respiratory circulation parameters during exercise\u20101990 report(in Japanese, English abstract)","volume":"56","author":"Murayama M","year":"1992","unstructured":"Murayama M, Sotohata I, Kohro T, et\u00a0al. 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