Author + information
- Received November 8, 2016
- Revision received February 14, 2017
- Accepted March 2, 2017
- Published online June 4, 2018.
- Coppelia Goublaire, MDa,
- Maria Melissopoulou, MDa,
- David Lobo, MDb,
- Naozumi Kubota, MD, PhDa,
- Constance Verdonk, MDa,
- Claire Cimadevilla, MDa,
- Isabelle Codogno, MSa,
- Eric Brochet, MDa,
- Alec Vahanian, MD, PhDa,c,d and
- David Messika-Zeitoun, MD, PhDa,c,d,∗ ()
- aDepartment of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
- bDepartment of Anesthesiology and Surgical Intensive Care, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
- cINSERM U1148, Bichat Hospital, Paris, France
- dUniversity Paris VII, Faculté de Médecine Paris-Diderot, Paris, France
- ↵∗Address for correspondence:
Dr. David Messika-Zeitoun, Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 46 rue Henri Huchard, 75018 Paris, France.
Objectives This study sought to evaluate the prognostic value of mean pressure gradient (MPG) increase and peak systolic pulmonary artery pressure (SPAP) measured during exercise stress echocardiography in asymptomatic patients with aortic stenosis (AS).
Background Exercise testing is recommended in asymptomatic AS patients, but the additional value of exercise-stress echocardiography, especially the prognostic value of MPG increase and peak SPAP, is still debated.
Methods We enrolled all consecutive patients with pure, isolated, asymptomatic AS and preserved ejection fraction ≥50% and normal SPAP (<50 mm Hg) who underwent symptom-limited exercise echocardiography at our institution. Occurrence of AS-related events (symptoms or congestive heart failure) or occurrence of aortic valve replacement was recorded.
Results We enrolled 148 patients (66 ± 15 years of age; 74% males; MPG: 47 ± 13 mm Hg; SPAP: 34 ± 6 mm Hg). No complications were observed. Thirty-six patients (24%) had an abnormal exercise test result (occurrence of symptoms, fall in blood pressure, and/or ST-segment depression) and were referred for surgery. Among the 112 patients with a normal exercise test result, 38 patients (34%) had abnormal exercise echocardiography scores (MPG increase >20 mm Hg and/or SPAP at peak exercise >60 mm Hg). These 112 patients were managed conservatively. During a mean follow-up of 14 ± 8 months, an AS-related event occurred in 30 patients, and 25 patients underwent surgery. Neither MPG increase >20 mm Hg nor peak SPAP >60 mm Hg was predictive of occurrence of AS-related events or aortic valve replacement (all p > 0.20). In contrast, baseline AS severity was an important prognostic factor (all p < 0.01).
Conclusions In this observational study including 148 patients with asymptomatic AS, we confirmed and extended the importance of exercise testing for unveiling functional limitation. More importantly, neither the increase in MPG nor in SPAP at peak exercise was predictive of outcome. Our results do not support the use of these parameters in risk-stratification and clinical management of asymptomatic AS patients.
Dr. Melissopoulou was supported by Association Citadelle Recherche et Formation du Citadelle Chateau Rouge de la Citadelle de Liège. The COFRASA (NCT00338676) and GENERAC (NCT00647088) studies are supported by grants from Assistance Publique-Hôpitaux de Paris (Projet Hospitalier de Recherche Clinique [PHRC] National 2005 and 2010, and PHRC regional 2007). Dr. Vahanian has received speaker honoraria from Edwards LifeSciences, Valtech, and Abbott Vascular. Dr. Messika-Zeitoun has received honoraria/research grants from Edwards LifeSciences, Valtech, Abbott Vascular, Cardiowave, and Mardil. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 8, 2016.
- Revision received February 14, 2017.
- Accepted March 2, 2017.
- 2018 American College of Cardiology Foundation
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