Nilsson H; Linkoping University, Linkoping,Sweden
Bellander C; Carlen A; Nylander E; Hedman K; Tamas E

Open Heart. 12(1), 2025 Jan 21.
VI 1

AIMS: Exercise testing remains underused in patients with aortic stenosis
(AS), partly due to concerns about an exercise-induced drop in systolic
blood pressure (SBP). We aimed to study the SBP response to exercise in
patients with severe symptomatic AS prior to surgery and 1 year
postoperatively.

METHODS: Patients scheduled for aortic valve replacement due to severe
symptomatic AS were enrolled at a single centre in a prospective
observational cohort study. Maximal cardiopulmonary exercise testing
(CPET) was performed on a cycle ergometer at baseline and 1 year
postoperatively, using standard termination criteria. The SBP response was
categorised according to the last measurements of SBP during exercise, in
relation to workload (the SBP/watt-slope) as ‘normal’ (>0.25 mm Hg/watt),
‘flat’ (0-0.25 mm Hg/watt) or ‘drop’ (<0 mm Hg/watt).

RESULTS: 45 patients (28 male, 66+/-9 years, left ventricular ejection
fraction 59%+/-5%, aortic jet velocity 4.6+/-0.5 m/s) were included, with
pairwise comparison available in 31 cases. There were no adverse events.
Preoperatively, 4/45 patients were categorised as ‘drop’, 23 as ‘flat’ and
18 as ‘normal’. There was a change in the distribution of categories from
preoperative to postoperative measurements (43% ‘normal’ vs 74% ‘normal’,
p=0.0046). Maximal SBP and workload-indexed SBP were higher
postoperatively than preoperatively (203+/-26 vs 182+/-28 mm Hg, p<0.001
and 0.43+/-0.14 vs 0.29+/-0.15 mm Hg/watt, p<0.001).

CONCLUSION: As a drop in SBP was infrequent (<10%) in patients with
severe symptomatic AS and no adverse events occurred, our results indicate
that CPET may be performed under careful monitoring in AS patients.
Postoperatively, the SBP reaction improved, with no patient having a drop
in SBP.