Table 1

Impact of Exercise Testing on Outcome and Clinical Decision Making in Patients With Asymptomatic AS

Stress DataParametersImpact on OutcomeRef. #Impact on Clinical Decision (AVR)
ESC GuidelinesACC/AHA Guidelines
ClinicalSymptoms (dizziness, dyspnea at low workload, angina, syncope)Onset of symptoms, cardiac-related death, AVR dictated by symptoms(19,21,45)Class I (level of evidence: C)Class IIb (level of evidence: C)
Abnormal blood pressure response (fall in blood pressure)Class IIa (level of evidence: C)Class IIb (level of evidence: C)
ElectrocardiographicVentricular arrhythmias
ST-segment depression (≥2 mm)
Onset of symptoms, cardiac-related death, AVR dictated by symptoms(19,21,45)Class IIb (level of evidence: C)
EchocardiographicIncrease in mean aortic pressure gradient: >18 or 20 mm HgSpontaneous symptoms, cardiac-related death, AVR dictated by symptoms, hospitalization for heart failure(14,22)Class IIb (level of evidence: C)
Decrease/small increase in LV ejection fractionSpontaneous symptoms, cardiac-related death, abnormal exercise test(18)
Exercise PHTReduced cardiac event-free survival, high rate of cardiac death(13)

ACC/AHA = American College of Cardiology/American Heart Association; AS = aortic stenosis; AVR = aortic valve replacement; ESC = European Society of Cardiology; LV = left ventricular; PHT = pulmonary arterial hypertension.