title: [Asymptomatic severe aortic stenosis with preserved left ventricular ejection fraction. Evaluation by exercise test: which results and which decision?].
abstract: Aortic stenosis is the most common valvular heart disease in Europe and North America and it is a real public health problem. Its prevalence increases with population aging. Symptomatic patients require surgery (class I, level of evidence B). In asymptomatic patients, a stress test with or without imaging is recommended to unmask the false asymptomatic patients and refine risk stratification of occurrence of major events. This support remains difficult and makes the optimal timing for surgery controversial in the absence of prospective data on the determinants of aortic stenosis progression, multicenter studies on risk stratification or randomized studies on patient management. The complexity of care arises from the balance between the spontaneous disease risk (risk of sudden death and irreversible left ventricular dysfunction) and the risk of surgery and prosthetic complications. It is therefore crucial to identify subgroups of patients at risk of pejorative progression in whom prophylactic surgery may be considered. This article focuses on evaluating during exercise asymptomatic patients with severe aortic stenosis and preserved left ventricular ejection fraction. We will explain how to perform the test, determine which echocardiographic measurements should be obtained, focusing on the diagnostic and prognostic value of these measurements and discuss indications for surgery according to new practice guidelines.
authors: Service de cardiologie et de maladies vasculaires, CHU Ibn Rochd, Casablanca, Maroc; Département de cardiologie, clinique de la valve, CHU Sart-Tilman, Liège, Belgique. Electronic address: ilham.bensahi@gmail.com.
authors: I
authors: I
authors: Bensahi
authors: Service de cardiologie et de maladies vasculaires, CHU Ibn Rochd, Casablanca, Maroc; Département de cardiologie, clinique de la valve, CHU Sart-Tilman, Liège, Belgique.
authors: A
authors: A
authors: Elfhal
authors: Département de cardiologie, CHU de Limoges, Limoges, France.
authors: J
authors: J
authors: Magne
authors: Département de cardiologie, clinique de la valve, CHU Sart-Tilman, Liège, Belgique.
authors: R
authors: R
authors: Dulgheru
authors: Département de cardiologie, clinique de la valve, CHU Sart-Tilman, Liège, Belgique.
authors: P
authors: P
authors: Lancellotti
authors: Département de cardiologie, clinique de la valve, CHU Sart-Tilman, Liège, Belgique. Electronic address: lpierard@chu.ulg.ac.be.
authors: L
authors: L
authors: Pierard
mesh_terms: D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D018450:Disease Progression; D025401:Echocardiography, Stress / Q000379:methods; D005060:Europe / Q000453:epidemiology; D005080:Exercise Test; D006801:Humans; D009656:North America / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume
keywords: Aortic stenosis; Echocardiography; Exercise test; Fonction ventriculaire gauche; Left ventricular function; Sténose aortique; Test à l’effort; Échocardiographie