Prognostic Usefulness of Cardiopulmonary Exercise Testing for Managing Patients With Severe Aortic Stenosis.

Le VD; Jensen GV; Kjøller-Hansen L,

The American Journal Of Cardiology [Am J Cardiol], ISSN: 1879-1913, 2017 Sep 01; Vol. 120 (5), pp. 844-849;
Publisher: Excerpta Medica; PMID: 28705379;

The approach to managing
asymptomatic or questionably symptomatic patients for aortic stenosis
is difficult. We aimed to determine whether cardiopulmonary exercise
testing (CPET) is prognostically useful in such patients. Patients
judged asymptomatic or questionably symptomatic for aortic stenosis
with aortic valve area index <0.6 cm2/m2 and left ventricular ejection
fraction ≥0.50 were managed conservatively provided they had either
(group 1) normal peak oxygen consumption and peak oxygen pulse (>83%
and >95% of the predicted values, respectively) or (group 2) subnormal
peak oxygen consumption or peak oxygen pulse but with CPET data
pointing to pathologies other than hemodynamic compromise from aortic
stenosis. Increase in systolic blood pressure <20 mm Hg, ST
depression ≥2 mm, or symptoms during the exercise test were allowed.
Unexpected events included cardiac death or hospitalization with heart
failure in patients who had not been recommended valve replacement. The
median age of the study population (n = 101) was 75 years
(interquartile range 65 to 79 years), and 67% were judged questionably
symptomatic. During a follow-up at 24 ± 6 months, the rate of
unexpected cardiac death and unexpected hospitalization with heart
failure was 0% and 6.0%, respectively. All-cause mortality was 4.0%
compared with 8.0% in the age- and gender-matched population. For group
1, 26 of 70 (37.1%) succumbed to cardiac death, or were hospitalized
because of heart failure, or underwent valve replacement, and for group
2 this was 12 of 31 (38.7%). In conclusion, if CPET does not indicate a
significant hemodynamic compromise because of aortic stenosis, an
initially conservative strategy results in a good prognosis and an
acceptable event rate.