An exercise-induced increase in mean gradient >20 mmHg during stress echocardiography predicted symptom-driven valve replacement or cardiovascular death (HR 3.83; 95% CI 2.16-6.67; P<0.0001).
Cohort (n=135)
Does exercise-stress echocardiography provide incremental prognostic value over resting echocardiography in asymptomatic patients with aortic stenosis and a normal exercise response?
Exercise-stress echocardiography provides incremental prognostic value in asymptomatic patients with aortic stenosis and a normal exercise response, specifically through exercise-induced increases in transvalvular gradient.
Effect estimate: HR 3.83 (95% CI 2.16-6.67)
p-value: p=< 0.0001
Aims Abnormal exercise test defined as the occurrence of exercise limiting symptoms, fall in blood pressure below baseline, or complex ventricular arrhythmias is useful to predict clinical events in asymptomatic patients with aortic stenosis (AS). The purpose of this study was to determine whether exercise-stress echocardiography (ESE) adds any incremental prognostic value to resting echocardiography in patients with AS having a normal exercise response. Methods and results One hundred and eighty-six asymptomatic patients with at least moderate AS and preserved LV ejection fraction (>/=50%) were assessed by Doppler-echocardiography at rest and during a maximum ramp semi-supine bicycle exercise test. Fifty-one (27%) patients had an abnormal exercise test and were excluded from the present analysis. Among the 135 patients with normal exercise test, 67 had an event (aortic valve replacement motivated by symptoms or cardiovascular death) at a mean follow-up of 20 +/- 14 months. The variables independently associated with events were: age >/=65 years hazard ratio (HR) = 1.96; 95% confidence interval (CI): 1.15-3.47; P = 0.01, diabetes, (HR = 3.20; 95% CI: 1.33-6.87; P = 0.01), LV hypertrophy (HR = 1.96; 95% CI: 1.17-3.27; P = 0.01), resting mean gradient >35 mmHg (HR = 3.60; 95% CI: 2.11-6.37; P 20 mmHg (HR = 3.83; 95% CI: 2.16-6.67; P < 0.0001). Conclusion The exercise-induced increase in transvalvular gradient may be helpful to improve risk stratification in asymptomatic AS patients with normal exercise response. These results thus suggest that ESE may provide additional prognostic information over that obtained from standard exercise testing and resting echocardiography.
Maréchaux et al. (2010) conducted a cohort in Aortic valve stenosis (n=135). Exercise-stress echocardiography vs. Resting echocardiography was evaluated on Aortic valve replacement motivated by symptoms or cardiovascular death (HR 3.83, 95% CI 2.16-6.67, p=< 0.0001). An exercise-induced increase in mean gradient >20 mmHg during stress echocardiography predicted symptom-driven valve replacement or cardiovascular death (HR 3.83; 95% CI 2.16-6.67; P<0.0001).