Does exercise echocardiography have an added value over exercise testing alone in asymptomatic patients with severe aortic stenosis?

Daniel Weisenberg*, Yaron Shapira, Mordehay Vaturi, Daniel Monakier, Zaza Iakobishvili, Alexander Battler, Alex Sagie

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Background and aim of the study: The study aim was to assess the clinical utility and added value of exercise stress echocardiography (ESE) over exercise testing alone in asymptomatic patients with severe aortic stenosis (AS). Methods: The results of treadmill ESE in 101 consecutive patients (59 males, 42 females; mean age 69 ± 10 years; range: 35-85 years) with asymptomatic severe AS (aortic valve area (AVA) <1 cm2 and/or mean transvalvular pressure gradient ≥50 mmHg) and normal left ventricular function, were analyzed. The test was considered abnormal if stopped prematurely because of limiting symptoms, a fall or small rise in systolic blood pressure, or complex ventricular arrhythmia. Results: The mean resting AVA was 0.74 ± 0.13 cm2, and peak and mean transvalvular gradients were 91 ± 19 and 57 ± 13 mmHg, respectively. In total, 69 patients (68%) developed an abnormal response, including symptoms (n = 48) and abnormal blood pressure response (n = 44). There were no cases of syncope or other major complications. Exercise transaortic pressure gradients could not be used to discriminate patients with otherwise normal and abnormal ESE or cardiac events. An abnormal contractile response was observed in 12 patients, in seven of whom it was the only ESE abnormal parameter. A total of 96 patients (95%) was followed up for a mean of 35 ± 14 months. Aortic valve replacement-free survival was significantly lower in patients with an abnormal ESE result compared to those with a normal result. Conclusion: ESE has a limited added value to exercise testing alone in asymptomatic patients with severe AS. In a small percentage of these cases an abnormal contractile response, despite otherwise normal exercise parameters, constitutes a new finding that deserves further investigation.

Original languageEnglish
Pages (from-to)376-380
Number of pages5
JournalJournal of Heart Valve Disease
Volume17
Issue number4
StatePublished - Jul 2008

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