Argument for a Doppler echocardiography during exercise in assessing asymptomatic patients with severe aortic stenosis.
OBJECTIVE
Exercise stress testing (EST) is recommended by guidelines to risk-stratify patients with asymptomatic valvular aortic stenosis (AS), though the role of quantitative exercise-Doppler echocardiography has rarely been studied. This prospective study sought to correlate standard EST results with the haemodynamic measurements made during exercise by Doppler echocardiography.


RESULTS
We performed rest and semi-supine exercise Doppler echocardiography in 44 consecutive patients (mean age=68+/-12 years) with aortic valve areas<or=0.6 cm2/m2. The effective aortic valve area (EOA), cardiac output (CO), maximal transvalvular velocity, and pulmonary pressure were monitored over the test. No serious adverse event was observed. EST was positive in 26 (Group 1) and negative in 18 (Group 2) patients. Baseline echocardiographic measurements were similar (EOA 0.77+/-0.15 vs. 0.78+/-0.14 cm2; CO 5.5+/-1.6 vs. 5.9+/-2 L/min) in both groups. Exercise-induced changes in CO (+2.9+/-2 vs. +4.3+/-1.8 L/min, P=0.04) and EOA (-0.04+/-0.18 vs. +0.15+/-0.24 cm2, P=0.015) were significantly greater in Group 2. A correlation between changes in EOA and changes in CO during exercise was observed, but significantly higher in Group 2 (P=0.04).


CONCLUSIONS
In the presence of severe asymptomatic AS, exercise Doppler echocardiography, assessing the mechanisms behind a positive EST, appears very promising but further studies with prognosis assessment remain necessary.
Leurent
Guillaume
G
Département de Cardiologie et Maladies Vasculaires, Centre Cardio-Pneumologique, CHU Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes Cedex, France.
Donal
Erwan
E
de Place
Christian
C
Chabanne
Céline
C
Gervais
Renaud
R
Fougerou
Claire
C
le Helloco
Alain
A
Daubert
Jean-Claude
JC
Mabo
Philippe
P
Laurent
Marcel
M
D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D002302:Cardiac Output; D004452:Echocardiography / Q000379:methods; D015150:Echocardiography, Doppler / Q000379:methods*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D012044:Regression Analysis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume