title: Exercise echocardiography in asymptomatic patients with severe aortic stenosis and preserved left ventricular ejection fraction.
abstract: The management of asymptomatic patients with severe aortic stenosis (AS) remains controversial. Recent series reported that early aortic valve replacement might be associated with improved clinical outcomes. However, the risk-benefit ratio should be carefully evaluated and early surgery only be proposed to a subset of asymptomatic patients considered at higher risk. Exercise echocardiography can help unmask symptomatic patients combined with assessment of the hemodynamic consequences of AS. Recent studies have demonstrated that exercise echocardiography can provide incremental prognostic value to identify patients who may benefit most from early surgery. In "truly" asymptomatic patients, an increase in mean aortic gradient ≥ 18-20 mmHg, a limited left ventricular contractile reserve or a pulmonary hypertension during exercise are predictive parameters of adverse cardiac events. Exercise echocardiography is low-cost, safe and available in many referral centers, and does not expose patients to radiation. The purpose of this article is to describe the role of exercise testing and echocardiography in the management of asymptomatic patients with severe AS and preserved left ventricular ejection fraction.
authors.affiliation: Department of Cardiology and Heart Valve Clinic, GIGA Cardiovascular Sciences, University of Liège, CHU Sart Tilman, Liège, Belgium.
authors.forename: Christine
authors.initials: C
authors.lastname: Henri
authors.affiliation: Department of Cardiology and Heart Valve Clinic, GIGA Cardiovascular Sciences, University of Liège, CHU Sart Tilman, Liège, Belgium.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
keywords: Aortic stenosis; Exercise echocardiography; Exercise testing
references.citation: J Am Coll Cardiol. 2006 May 2;47(9):1891-900
references.pmid: 16682317
references.citation: Heart. 2001 Oct;86(4):381-6
references.pmid: 11559673
references.citation: Curr Opin Cardiol. 2013 Sep;28(5):531-9
references.pmid: 23835948
references.citation: Eur J Echocardiogr. 2008 May;9(3):338-43
references.pmid: 17604696
references.citation: Circulation. 2005 Aug 30;112(9 Suppl):I377-82
references.pmid: 16159850
references.citation: Eur Heart J. 2005 Jul;26(13):1309-13
references.pmid: 15820999
references.citation: Am J Cardiol. 2009 Oct 1;104(7):972-7
references.pmid: 19766766
references.citation: Eur Heart J. 2009 Feb;30(3):278-89
references.pmid: 19001473
references.citation: Eur Heart J. 2012 Oct;33(19):2451-96
references.pmid: 22922415
references.citation: Eur Heart J. 2010 Jun;31(11):1390-7
references.pmid: 20308041
references.citation: J Thorac Cardiovasc Surg. 2008 Feb;135(2):308-15
references.pmid: 18242258
references.citation: J Am Soc Echocardiogr. 2007 Sep;20(9):1021-41
references.pmid: 17765820
references.citation: Echocardiography. 2007 Oct;24(9):955-9
references.pmid: 17894574
references.citation: Eur J Echocardiogr. 2011 Mar;12(3):235-41
references.pmid: 21245060
references.citation: Circulation. 2012 Aug 14;126(7):851-9
references.pmid: 22832784
references.citation: J Am Coll Cardiol. 2009 Dec 8;54(24):2251-60
references.pmid: 19958961
references.citation: Eur J Echocardiogr. 2009 Jan;10(1):69-73
references.pmid: 18492656
references.citation: Heart. 2007 Jun;93(6):732-8
references.pmid: 17090563
references.citation: Eur Heart J. 2003 Jul;24(13):1231-43
references.pmid: 12831818
references.citation: Eur J Echocardiogr. 2009 May;10(3):414-9
references.pmid: 18996958
references.citation: Eur Heart J. 2013 Jun;34(21):1597-606
references.pmid: 23293304
references.citation: Heart. 2010 Sep;96(17):1364-71
references.pmid: 20483891
references.citation: JAMA. 2009 Jan 21;301(3):286-94
references.pmid: 19155455
references.citation: Am Heart J. 2004 Oct;148(4):696-702
references.pmid: 15459603
references.citation: Circulation. 2002 Oct 1;106(14):1883-92
references.pmid: 12356646
references.citation: Am J Cardiol. 2010 Feb 1;105(3):383-8
references.pmid: 20102953