Management of asymptomatic patients with severe aortic stenosis remains a source of debate. Exercise testing is no longer contraindicated and needs now to be entertained when evaluating asymptomatic patients with severe aortic valve stenosis (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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