title: Treatment decision in asymptomatic aortic valve stenosis: role of exercise testing.
abstract: OBJECTIVE
  To determine the prognostic value of exercise testing, valve area, and maximum transaortic pressure gradient in asymptomatic patients with aortic valve stenosis.
  
  
  METHODS
  The outpatient service of a tertiary referral centre for cardiology.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  66 consecutive patients with isolated severe aortic stenosis (aortic valve area </= 1.0 cm(2)) were selected over a 58 month period. Mean (SD) follow up was 14.77 (11.93) months.
  
  
  METHODS
  At the initial visit Doppler echocardiography and exercise testing were performed to evaluate ST segment depression and the development of symptoms of aortic stenosis, ventricular arrhythmia, or inadequate rise of systolic blood pressure during exercise. Follow up clinical examinations were performed every three months thereafter to record the onset of symptoms.
  
  
  METHODS
  Sudden death or the development of symptoms.
  
  
  RESULTS
  Eight patients developed dizziness during exercise testing but made a rapid and spontaneous recovery. No other complications of exercise testing occurred. Survival curves, with or without the occurrence of end point events for the variables studied, showed significant differences for positive versus negative exercise testing (p = 0.0001) and aortic valve area < 0.7 cm(2) v >/= 0.7 cm(2) (p = 0.0021). There was no relation between the end points and transaortic gradient (p = 0.6882). In multivariate analysis, a hazard ratio of 7.43 was calculated for patients with a positive versus a negative exercise stress test. Although asymptomatic in daily life, 6% of the patients (4/66) experienced sudden death; all these had a positive exercise test and an aortic valve area of </= 0.6 cm(2).
  
  
  CONCLUSIONS
  Exercise testing is safe and is of prognostic value in asymptomatic patients with aortic stenosis.
authors.affiliation: Heart Institute (InCor) of the University of São Paulo and Jaraguá Hospital, Av Juriti 144-Moema, 04520-000 São Paulo, Brazil. marisa@checkup.med.br
authors.forename: M C
authors.initials: MC
authors.lastname: Amato
authors.forename: P J
authors.initials: PJ
authors.lastname: Moffa
authors.forename: K E
authors.initials: KE
authors.lastname: Werner
authors.forename: J A
authors.initials: JA
authors.lastname: Ramires
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D001794:Blood Pressure; D015331:Cohort Studies; D000075202:Contraindications; D003657:Decision Making; D018572:Disease-Free Survival; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors