title: The value of cardiopulmonary exercise testing in individuals with apparently asymptomatic severe aortic stenosis: a pilot study.
abstract: BACKGROUND
  Risk stratification in asymptomatic patients with severe aortic stenosis (AS) is based on exercise test results. However, differentiating between pathological and physiological breathlessness during exercise is sometimes challenging. Cardiopulmonary exercise testing (CPET) may improve quantification of cardiopulmonary exercise capacity in patients with valve diseases.
  
  
  OBJECTIVE
  To assess the ability of CPET to detect abnormal responses to exercise and a clinical endpoint (occurrence of European Society of Cardiology guidelines surgical class I triggers).
  
  
  METHODS
  Forty-three consecutive patients (mean age 69±13 years; 31 men) with no reported symptoms and severe AS (aortic valve surface area<1 cm2 or indexed aortic valve surface area ≤0.6 cm2/m2) prospectively underwent symptom-limited CPET.
  
  
  RESULTS
  Twelve (28%) patients had an abnormal exercise test (AET) with symptoms (abnormal dyspnoea n=11; angina n=1). Both VE/VCO2 slope>34 (hazard ratio [HR]=5.76, 95% confidence interval [CI] 1.086-30.587; P=0.04) and peak VO2≤14 mL/kg/min (HR 6.01, 95% CI 1.153-31.275; P=0.03) were independently associated with an AET. Furthermore, VE/VCO2 slope>34 (HR 3.681, 95% CI 1.318-10.286; P=0.013) and peak VO2≤14 mL/kg/min (HR 3.058, 95% CI 1.074-8.713; P=0.036) were independent predictors of reaching the clinical endpoint.
  
  
  CONCLUSIONS
  Cardiopulmonary exercise testing is a useful tool for characterizing breathlessness during an exercise test in apparently asymptomatic patients with AS. Peak VO2≤14 mL/kg/min and VE/VCO2 slope>34 were associated with an AET and the occurrence of European Society of Cardiology guideline surgical class I triggers.
authors.affiliation: Inserm U1088, Department of Cardiology, Amiens University Hospital, avenue Laennec, 80054 Amiens cedex 1, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Levy
authors.affiliation: Inserm U1088, Department of Cardiology, Amiens University Hospital, avenue Laennec, 80054 Amiens cedex 1, France.
authors.forename: Nader
authors.initials: N
authors.lastname: Fayad
authors.affiliation: Inserm U1088, Department of Cardiology, Amiens University Hospital, avenue Laennec, 80054 Amiens cedex 1, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Jeu
authors.affiliation: Inserm U1088, Department of Cardiology, Amiens University Hospital, avenue Laennec, 80054 Amiens cedex 1, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Choquet
authors.affiliation: Inserm U1088, Department of Cardiology, Amiens University Hospital, avenue Laennec, 80054 Amiens cedex 1, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Szymanski
authors.affiliation: Inserm U1088, Department of Cardiology, Amiens University Hospital, avenue Laennec, 80054 Amiens cedex 1, France.
authors.forename: Dorothée
authors.initials: D
authors.lastname: Malaquin
authors.affiliation: Inserm U1088, Department of Cardiology, Amiens University Hospital, avenue Laennec, 80054 Amiens cedex 1, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Peltier
authors.affiliation: Inserm U1088, Department of Cardiology, Amiens University Hospital, avenue Laennec, 80054 Amiens cedex 1, France. Electronic address: tribouilloy.christophe@chu-amiens.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011379:Prognosis; D015203:Reproducibility of Results; D012720:Severity of Illness Index
keywords: Abnormal exercise test; Asymptomatic aortic stenosis; Cardiopulmonary exercise testing; Sténose aortique serrée asymptomatique; Test d’effort anormal; Épreuve d’effort cardiorespiratoire