title: Cardiopulmonary exercise testing is a better outcome predictor than exercise echocardiography in asymptomatic aortic stenosis.
abstract: BACKGROUND
  Objective assessment of maximal aerobic capacity using peak oxygen consumption (peak VO2) can be helpful in the management of patients with asymptomatic aortic stenosis (AS). The relationship between peak VO2 and AS severity criteria derived from rest and supine exercise echocardiography (SEE) has never been explored.
  
  
  OBJECTIVE
  We aimed to determine whether low peak VO2 (<85% of predicted value) is associated with severity parameters in SEE, and poor clinical outcome.
  
  
  METHODS
  Fifty one asymptomatic patients (mean age of 54±21years) with moderate to severe aortic stenosis (Vmax>3m/s) and left ventricle ejection fraction>50% prospectively underwent resting and SEE and cardiopulmonary exercise testing (CPX).
  
  
  RESULTS
  Peak VO2 was lower than expected (21.9±7.4mL/kg/min), i.e. <85% of predicted value in 57% patients, secondary to cardiac limitation in most of them (69%). In multiple regression analysis, age, BMI and female gender were the only independent determinants of peak VO2. Interestingly no parameter derived from SEE was associated with peak VO2. After 21±7month follow-up, no patient died, 20 underwent cardiac surgery. Peak VO2<85% of predicted value was associated with lower event free survival compared to normal peak VO2 (57%±11% vs 93±6%, p=0.036) whereas no exercise echocardiographic parameter could predict such events. Peak VO2≥85% had a negative predictive value of 97%.
  
  
  CONCLUSIONS
  CPX detects a high proportion of false asymptomatic AS patients with poorer outcome that cannot be predicted by SEE markers of AS severity. Assessment of aerobic capacity should be part of current approach within a "watchful waiting" strategy.
authors.affiliation: CHU Lille, Department of Echocardiography and Physiology, Department of Pediatric Cardiology and Congenital Heart Diseases, F-59000 Lille, France. Electronic address: Olivia.domanski@chru-lille.fr.
authors.forename: Olivia
authors.initials: O
authors.lastname: Domanski
authors.affiliation: CHU Lille, Department of Echocardiography and Physiology, Department of Pediatric Cardiology and Congenital Heart Diseases, F-59000 Lille, France.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Richardson
authors.affiliation: CHU Lille, Department of Echocardiography and Physiology, Department of Pediatric Cardiology and Congenital Heart Diseases, F-59000 Lille, France; Univ. Lille, F-59000 Lille, France; Inserm UMR 1011, F-59000 Lille, France; Institut Pasteur de Lille, F-59000 Lille, France; European Genomic Institute for Diabetes (E.G.I.D.), FR 3508, F-59000 Lille, France.
authors.forename: Augustin
authors.initials: A
authors.lastname: Coisne
authors.affiliation: CHU Lille, Department of Echocardiography and Physiology, Department of Pediatric Cardiology and Congenital Heart Diseases, F-59000 Lille, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Polge
authors.affiliation: CHU Lille, Department of Echocardiography and Physiology, Department of Pediatric Cardiology and Congenital Heart Diseases, F-59000 Lille, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Mouton
authors.affiliation: CHU Lille, Department of Echocardiography and Physiology, Department of Pediatric Cardiology and Congenital Heart Diseases, F-59000 Lille, France; Univ. Lille, F-59000 Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Godart
authors.affiliation: CHU Lille, Department of Echocardiography and Physiology, Department of Pediatric Cardiology and Congenital Heart Diseases, F-59000 Lille, France; Univ. Lille, F-59000 Lille, France.
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Edmé
authors.affiliation: CHU Lille, Department of Echocardiography and Physiology, Department of Pediatric Cardiology and Congenital Heart Diseases, F-59000 Lille, France; Univ. Lille, F-59000 Lille, France; Institut Pasteur de Lille, F-59000 Lille, France.
authors.forename: Regis
authors.initials: R
authors.lastname: Matran
authors.affiliation: University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
authors.affiliation: CHU Lille, Department of Echocardiography and Physiology, Department of Pediatric Cardiology and Congenital Heart Diseases, F-59000 Lille, France; Univ. Lille, F-59000 Lille, France; Inserm UMR 1011, F-59000 Lille, France; Institut Pasteur de Lille, F-59000 Lille, France; European Genomic Institute for Diabetes (E.G.I.D.), FR 3508, F-59000 Lille, France.
authors.forename: David
authors.initials: D
authors.lastname: Montaigne
mesh_terms: D000328:Adult; D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D058070:Asymptomatic Diseases; D004452:Echocardiography / Q000379:methods / Q000592:standards*; D005080:Exercise Test / Q000379:methods / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Aerobic capacity; Aortic stenosis; Cardiopulmonary exercise testing; Exercise echocardiography; Peak oxygen consumption