Left ventricular response to exercise in aortic stenosis: an exercise echocardiographic study.
BACKGROUND
While normal at rest, left ventricular (LV) systolic function may become abnormal during exercise in patients with aortic stenosis. Once contraindicated in patients with aortic stenosis, exercise testing is now recommended in asymptomatic patients with aortic stenosis to elicit symptoms and thereby ascertain the need for aortic valve replacement. However, the clinical significance of an abnormal LV response to exercise in asymptomatic patients with aortic stenosis remains unknown.


OBJECTIVE
The aim of this study was to evaluate the clinical implications of an abnormal LV response during exercise in the setting of aortic stenosis.


METHODS
We monitored the LV response to exercise by 2D-Doppler echocardiography during a symptom limited semirecumbent bicycle exercise in 50 patients with tight aortic stenosis (aortic valve area < or = 1.0 cm(2)) and a normal LV systolic function (LV ejection fraction, EF > or = 50%) and followed them for an average of 11 months.


RESULTS
Twenty patients had an abnormal LV response to exercise with a mean decrease in LV EF from 64 +/- 10 to 53 +/- 12% while 30 patients had a normal LV response to exercise with a mean increase in LV EF from 62 +/- 7 to 70 +/- 8%. Patients with an abnormal LV response during exercise were more likely to develop symptoms during exercise than patients with a normal LV response: 80% versus 27% (P< 0.0001). The survival free of cardiac events was significantly lower in patients with abnormal LV response to exercise than in patients with a normal response (P = 0.03).


CONCLUSIONS
Exercise echocardiography provides objective data that facilitate interpretation of exercise elicited symptoms in asymptomatic patients with severe aortic stenosis. In addition, an abnormal LV response to exercise may predict a poor outcome.
Maréchaux
Sylvestre
S
Cardiology Hospital, Lille University Medical Center, CRHU Lille, Boulevard Pr J Leclerc, Lille, France.
Ennezat
Pierre-Vladimir
PV
LeJemtel
Thierry H
TH
Polge
Anne-Sophie
AS
de Groote
Pascal
P
Asseman
Philippe
P
Nevière
Rémi
R
Le Tourneau
Thierry
T
Deklunder
Ghislaine
G
D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology