Heart 2009;95:877-884
REVIEW
Exercise testing and exercise stress echocardiography in asymptomatic aortic valve stenosis
1 Centre Hospitalier Régional et Universitaire de Lille, EA2693/Division of Cardiology, France
2 Physiology and Ultrasound Laboratory, Lille, France
3 Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
4 Clinique Saint Augustin, Bordeaux, France
5 Division of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA
6 Hospital Laval Research Center/Québec Heart Institute, Laval University Quebec, Canada G1V-4G5
Dr Pierre V Ennezat, Cardiology Hospital, Intensive Care Unit, Bd Pr J Leclercq, 59037 Lille Cedex, France; ennezat{at}yahoo.com
Management of asymptomatic patients with severe aortic valve stenosis (AVS) remains a source of debate. Exercise testing is no longer contraindicated and needs now to be considered when evaluating asymptomatic patients with AVS. Several studies have clearly demonstrated that exercise-elicited symptoms during conventional upright exercise portends clinical events. Semi-supine exercise with continuous Doppler echocardiography monitoring elicits cardiovascular abnormalities that are not detected at rest. Abnormal left ventricular response to exercise and/or major increase in mean transvalvular gradient add to the prognostic value of elicited symptoms in asymptomatic patients with severe AVS. However, preliminary experience needs to be confirmed to warrant routine use of exercise Doppler echocardiography in the evaluation of patients with asymptomatic AVS.
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