Argument for a Doppler echocardiography during exercise in assessing asymptomatic patients with severe aortic stenosis |
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Authors: | Leurent Guillaume; Donal Erwan; de Place Christian; Chabanne Celine; Gervais Renaud; Fougerou Claire; le Helloco Alain; Daubert Jean-Claude; Mabo Philippe; Laurent Marcel |
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Institution: | 1 Département de Cardiologie et Maladies Vasculaires, Centre Cardio-Pneumologique, CHU Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes Cedex, France
2 Centre dInvestigation Clinique, INSERM 0203, CHU Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes Cedex, France
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Abstract: | Aims: Exercise stress testing (EST) is recommended by guidelines torisk-stratify patients with asymptomatic valvular aortic stenosis(AS), though the role of quantitative exercise-Doppler echocardiographyhas rarely been studied. This prospective study sought to correlatestandard EST results with the haemodynamic measurements madeduring exercise by Doppler echocardiography. Methods and results: We performed rest and semi-supine exercise Doppler echocardiographyin 44 consecutive patients (mean age = 68 ± 12 years)with aortic valve areas 0.6 cm2/m2. The effective aortic valvearea (EOA), cardiac output (CO), maximal transvalvular velocity,and pulmonary pressure were monitored over the test. No seriousadverse event was observed. EST was positive in 26 (Group 1)and negative in 18 (Group 2) patients. Baseline echocardiographicmeasurements were similar (EOA 0.77 ± 0.15 vs. 0.78 ±0.14 cm2; CO 5.5 ± 1.6 vs. 5.9 ± 2 L/min) in bothgroups. Exercise-induced changes in CO (+2.9 ± 2 vs.+4.3 ± 1.8 L/min, P = 0.04) and EOA (–0.04 ±0.18 vs. +0.15 ± 0.24 cm2, P = 0.015) were significantlygreater in Group 2. A correlation between changes in EOA andchanges in CO during exercise was observed, but significantlyhigher in Group 2 (P = 0.04). Conclusion: In the presence of severe asymptomatic AS, exercise Dopplerechocardiography, assessing the mechanisms behind a positiveEST, appears very promising but further studies with prognosisassessment remain necessary. |
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Keywords: | Aortic valve stenosis Exercise stress test Doppler echocardiography |
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