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Left Ventricular Response to Exercise in Aortic Stenosis: An Exercise Echocardiographic Study
Author(s) -
Maréchaux Sylvestre,
Ennezat PierreVladimir,
LeJemtel Thierry H.,
Polge AnneSophie,
Groote Pascal de,
Asseman Philippe,
Nevière Rémi,
Le Tourneau Thierry,
Deklunder Ghislaine
Publication year - 2007
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/j.1540-8175.2007.00501.x
Subject(s) - medicine , cardiology , asymptomatic , stenosis , ejection fraction , doppler echocardiography , aortic valve stenosis , haemodynamic response , heart failure , heart rate , blood pressure , diastole
Background: While normal at rest, left ventricular (LV) systolic function may become abnormal during exercise in patients with aortic stenosis. Once contraindicated in patients with aortic stenosis, exercise testing is now recommended in asymptomatic patients with aortic stenosis to elicit symptoms and thereby ascertain the need for aortic valve replacement. However, the clinical significance of an abnormal LV response to exercise in asymptomatic patients with aortic stenosis remains unknown.Objective: The aim of this study was to evaluate the clinical implications of an abnormal LV response during exercise in the setting of aortic stenosis.Methods: We monitored the LV response to exercise by 2D‐Doppler echocardiography during a symptom limited semirecumbent bicycle exercise in 50 patients with tight aortic stenosis (aortic valve area ≤ 1.0 cm 2 ) and a normal LV systolic function (LV ejection fraction, EF ≥ 50%) and followed them for an average of 11 months.Results: Twenty patients had an abnormal LV response to exercise with a mean decrease in LV EF from 64 ± 10 to 53 ± 12% while 30 patients had a normal LV response to exercise with a mean increase in LV EF from 62 ± 7 to 70 ± 8%. Patients with an abnormal LV response during exercise were more likely to develop symptoms during exercise than patients with a normal LV response: 80% versus 27% (P< 0.0001). The survival free of cardiac events was significantly lower in patients with abnormal LV response to exercise than in patients with a normal response (P = 0.03).Conclusion: Exercise echocardiography provides objective data that facilitate interpretation of exercise elicited symptoms in asymptomatic patients with severe aortic stenosis. In addition, an abnormal LV response to exercise may predict a poor outcome .