Editorial
Exercise testing to guide surgery in aortic stenosis
| The first 150 words of the full text of this article appear below. |
Exercise testing has a long but largely forgotten pedigree in the assessment of patients with aortic stenosis. Before the development of echocardiography, a blunted rise in systolic blood pressure and the development of ST segment depression on an ECG during exercise were used to differentiate severe from more mild stenosis in children.1 In adults, ST segment depression is not sufficiently well correlated with coronary disease to be clinically useful.2 3 However the symptomatic and blood pressure responses to exercise may aid the timing of surgery in patients with equivocal or no symptoms.
Why is an objective assessment of symptoms necessary?The prognosis in asymptomatic severe stenosis is widely regarded
as too good to justify prophylactic surgery. However, as soon as
symptoms develop, survival falls sharply and 10% of patients die
within the first few months.4 5 This figure is far higher than the surgical risk of isolated aortic valve replacement which, even
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McCANN, G P, MUIR, D F, HILLIS, W S
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