Prognostic Value and Safety of Serial Exercise Echocardiography in Asymptomatic Severe Aortic Stenosis
Background The prognostic value of serial exercise echocardiography (EEC) in asymptomatic severe aortic stenosis is unknown. We sought to evaluate the safety and utility of monitoring patients with asymptomatic severe aortic stenosis by annual EECs to refer them to aortic valve replacement (AVR) or...
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Wiley
2025-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.036599 |
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| author | Eric Abergel Clement Venner Christophe Tribouilloy Christophe Chauvel Marc Simon Rébecca Codiat Thierry Piechaud Vincent Maurin |
| author_facet | Eric Abergel Clement Venner Christophe Tribouilloy Christophe Chauvel Marc Simon Rébecca Codiat Thierry Piechaud Vincent Maurin |
| author_sort | Eric Abergel |
| collection | DOAJ |
| description | Background The prognostic value of serial exercise echocardiography (EEC) in asymptomatic severe aortic stenosis is unknown. We sought to evaluate the safety and utility of monitoring patients with asymptomatic severe aortic stenosis by annual EECs to refer them to aortic valve replacement (AVR) or to keep them under follow‐up. Methods and Results The cohort comprised 196 patients, with a normal screening EEC and a minimal follow‐up of 18 months. Follow‐up was planned until there was an indication for AVR, based on a resting transthoracic echocardiography at 6 months and then every year, and an EEC at 1 year and then every year (alternating resting transthoracic echocardiography and EEC every 6 months). During follow‐up, patients were referred to AVR if they reported symptoms, if rest transthoracic echocardiography was positive (left ventricular dysfunction, aortic maximal velocity ≥5 m/s, or severe valve calcification with aortic maximal velocity progression ≥0.3 m/s per year) or if EEC was positive (occurrence during exercise of any aortic stenosis‐related symptoms, significant ventricular arrhythmias, a drop or an insufficient rise (<20 mm Hg) in systolic blood pressure from baseline, or a left ventricular dysfunction). Among the 196 patients (76% men, aged 76.1±11.1 years), a mean 2.85±1.22 EECs were conducted. There were no serious complications during any of the EECs. Each serial transthoracic echocardiography at rest and each EEC yielded 0%–22% and 23.5%–50% of positive results, respectively, leading to AVR. We delayed AVR by a mean of 2.93±1.95 years after the screening EEC. No cardiac‐related death or sudden death was reported during the study. Conclusions Our findings demonstrate the safety and prognostic utility of serial EECs in the management of patients with asymptomatic severe aortic stenosis to guide timely AVR. |
| format | Article |
| id | doaj-art-a1ed2007c3ab4b699b61ed81a93f3a05 |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-a1ed2007c3ab4b699b61ed81a93f3a052025-08-20T03:07:41ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-01-0114110.1161/JAHA.124.036599Prognostic Value and Safety of Serial Exercise Echocardiography in Asymptomatic Severe Aortic StenosisEric Abergel0Clement Venner1Christophe Tribouilloy2Christophe Chauvel3Marc Simon4Rébecca Codiat5Thierry Piechaud6Vincent Maurin7Elsan Group, Clinique Saint Augustin Bordeaux FranceElsan Group, Clinique Saint Augustin Bordeaux FranceDepartment of Cardiology Amiens University Hospital Amiens FranceElsan Group, Clinique Saint Augustin Bordeaux FranceElsan Group, Clinique Saint Augustin Bordeaux FranceElsan Group, Clinique Saint Augustin Bordeaux FranceElsan Group, Cellule Recherche Clinique Nouvelle Aquitaine Bordeaux FranceElsan Group, Clinique Saint Augustin Bordeaux FranceBackground The prognostic value of serial exercise echocardiography (EEC) in asymptomatic severe aortic stenosis is unknown. We sought to evaluate the safety and utility of monitoring patients with asymptomatic severe aortic stenosis by annual EECs to refer them to aortic valve replacement (AVR) or to keep them under follow‐up. Methods and Results The cohort comprised 196 patients, with a normal screening EEC and a minimal follow‐up of 18 months. Follow‐up was planned until there was an indication for AVR, based on a resting transthoracic echocardiography at 6 months and then every year, and an EEC at 1 year and then every year (alternating resting transthoracic echocardiography and EEC every 6 months). During follow‐up, patients were referred to AVR if they reported symptoms, if rest transthoracic echocardiography was positive (left ventricular dysfunction, aortic maximal velocity ≥5 m/s, or severe valve calcification with aortic maximal velocity progression ≥0.3 m/s per year) or if EEC was positive (occurrence during exercise of any aortic stenosis‐related symptoms, significant ventricular arrhythmias, a drop or an insufficient rise (<20 mm Hg) in systolic blood pressure from baseline, or a left ventricular dysfunction). Among the 196 patients (76% men, aged 76.1±11.1 years), a mean 2.85±1.22 EECs were conducted. There were no serious complications during any of the EECs. Each serial transthoracic echocardiography at rest and each EEC yielded 0%–22% and 23.5%–50% of positive results, respectively, leading to AVR. We delayed AVR by a mean of 2.93±1.95 years after the screening EEC. No cardiac‐related death or sudden death was reported during the study. Conclusions Our findings demonstrate the safety and prognostic utility of serial EECs in the management of patients with asymptomatic severe aortic stenosis to guide timely AVR.https://www.ahajournals.org/doi/10.1161/JAHA.124.036599asymptomatic severe aortic stenosisexercise echocardiographyprognosissudden death |
| spellingShingle | Eric Abergel Clement Venner Christophe Tribouilloy Christophe Chauvel Marc Simon Rébecca Codiat Thierry Piechaud Vincent Maurin Prognostic Value and Safety of Serial Exercise Echocardiography in Asymptomatic Severe Aortic Stenosis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease asymptomatic severe aortic stenosis exercise echocardiography prognosis sudden death |
| title | Prognostic Value and Safety of Serial Exercise Echocardiography in Asymptomatic Severe Aortic Stenosis |
| title_full | Prognostic Value and Safety of Serial Exercise Echocardiography in Asymptomatic Severe Aortic Stenosis |
| title_fullStr | Prognostic Value and Safety of Serial Exercise Echocardiography in Asymptomatic Severe Aortic Stenosis |
| title_full_unstemmed | Prognostic Value and Safety of Serial Exercise Echocardiography in Asymptomatic Severe Aortic Stenosis |
| title_short | Prognostic Value and Safety of Serial Exercise Echocardiography in Asymptomatic Severe Aortic Stenosis |
| title_sort | prognostic value and safety of serial exercise echocardiography in asymptomatic severe aortic stenosis |
| topic | asymptomatic severe aortic stenosis exercise echocardiography prognosis sudden death |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.036599 |
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