title: Relationship between exercise pressure gradient and haemodynamic progression of aortic stenosis.
abstract: OBJECTIVE
  We hypothesized that large exercise-induced increases in aortic mean pressure gradient can predict haemodynamic progression during follow-up in asymptomatic patients with aortic stenosis.
  
  
  METHODS
  We retrospectively identified patients with asymptomatic moderate or severe aortic stenosis (aortic valve area<1.5cm2or<1cm2) and normal ejection fraction, who underwent an exercise stress echocardiography at baseline with a normal exercise test and a resting echocardiography during follow-up. The relationship between exercise-induced increase in aortic mean pressure gradient and annualised changes in resting mean pressure gradient during follow-up was investigated.
  
  
  RESULTS
  Fifty-five patients (mean age 66±15 years; 45% severe aortic stenosis) were included. Aortic mean pressure gradient significantly increased from rest to peak exercise (P<0.001). During a median follow-up of 1.6 [1.1-3.2] years, resting mean pressure gradient increased from 35±13mmHg to 48±16mmHg, P<0.0001. Median annualised change in resting mean pressure gradient during follow-up was 5 [2-11] mmHg. Exercise-induced increase in aortic mean pressure gradient did correlate with annualised changes in mean pressure gradient during follow-up (r=0.35, P=0.01). Hemodynamic progression of aortic stenosis was faster in patients with large exercise-induced increase in aortic mean pressure gradient (≥20mmHg) as compared to those with exercise-induced increase in aortic mean pressure gradient<20mmHg (median annualised increase in mean pressure gradient 19 [6-28] vs. 4 [2-10] mmHg/y respectively, P=0.002). Similar results were found in the subgroup of 30 patients with moderate aortic stenosis.
  
  
  CONCLUSIONS
  Large exercise-induced increases in aortic mean pressure gradient correlate with haemodynamic progression of stenosis during follow-up in patients with asymptomatic aortic stenosis. Further studies are needed to fully establish the role of ESE in the decision-making process in comparison to other prognostic markers in asymptomatic patients with aortic stenosis.
authors.affiliation: Service de cardiologie, GCS-groupement des hôpitaux de l'institut catholique de Lille, faculté libre de médecine, université catholique de Lille, 59000 Lille, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Ringle
authors.affiliation: Service de cardiologie B, CHU d'Amiens, 80054 Amiens, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Levy
authors.affiliation: Service de cardiologie, CHU de Grenoble, 38000 Grenoble, France.
authors.forename: Pierre-Vladimir
authors.initials: PV
authors.lastname: Ennezat
authors.affiliation: Service de cardiologie, GCS-groupement des hôpitaux de l'institut catholique de Lille, faculté libre de médecine, université catholique de Lille, 59000 Lille, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Le Goffic
authors.affiliation: Service de cardiologie, GCS-groupement des hôpitaux de l'institut catholique de Lille, faculté libre de médecine, université catholique de Lille, 59000 Lille, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Castel
authors.affiliation: Service de cardiologie, GCS-groupement des hôpitaux de l'institut catholique de Lille, faculté libre de médecine, université catholique de Lille, 59000 Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Delelis
authors.affiliation: Service de cardiologie, GCS-groupement des hôpitaux de l'institut catholique de Lille, faculté libre de médecine, université catholique de Lille, 59000 Lille, France.
authors.forename: Aymeric
authors.initials: A
authors.lastname: Menet
authors.affiliation: Service de cardiologie B, CHU d'Amiens, 80054 Amiens, France.
authors.forename: Dorothée
authors.initials: D
authors.lastname: Malaquin
authors.affiliation: Service de cardiologie, GCS-groupement des hôpitaux de l'institut catholique de Lille, faculté libre de médecine, université catholique de Lille, 59000 Lille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Graux
authors.affiliation: Service de chirurgie cardiaque, CHRU de Lille, 59000 Lille, France.
authors.forename: André
authors.initials: A
authors.lastname: Vincentelli
authors.affiliation: Service de cardiologie B, CHU d'Amiens, 80054 Amiens, France; Inserm U 1088, université de Picardie, 80054 Amiens, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
authors.affiliation: Service de cardiologie, GCS-groupement des hôpitaux de l'institut catholique de Lille, faculté libre de médecine, université catholique de Lille, 59000 Lille, France; Inserm U 1088, université de Picardie, 80054 Amiens, France. Electronic address: sylvestre.marechaux@yahoo.fr.
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Maréchaux
keywords: Aortic stenosis; Aortic valve; Echocardiography; Exercise; Progression; Rétrécissement aortique; Test d’effort; Valve aortique; Échocardiographie d’effort