Exercise test in patients with asymptomatic aortic stenosis: clinically useful or not?

INTRODUCTION

Aortic valve replacement (AVR) is recommended for symptomatic patients with severe aortic stenosis (AS). In asymptomatic AS (AAS), exercise testing (ET) is recommended; however, it remains controversial.

OBJECTIVES

The aim of our study was to assess the importance of ET in patients with AAS.

PATIENTS AND

METHODS

A total of 89 patients with AAS (53 men; mean [SD] age, 59.5 [11.7] years) underwent 244 symptom‑limited ETs.

RESULTS

All ETs were clinically negative. During the median (interquartile range) follow‑up of 22 (12) months, 39 patients (22 men) developed symptoms (the AVR group). This group was compared with 50 asymptomatic non‑AVR patients. In the multivariable Cox analysis, the maximal heart rate during ET less than 85% of age- and sex-adjusted maximal predicted heart rate (THR less than 85%) was related to AVR (P = 0.01). After adjusting for the use of β‑blockers, this was not significant (P = 0.08). In the β‑blocker subgroup, the THR less than 85% was significantly related to AVR in the univariable Cox analysis (hazard ratio, 2.2; 95% CI, 1.07-4.9; P = 0.03) and after adjusting for age (P = 0.047). This relationship was not observed in patients who did not receive β‑blockers.

CONCLUSION

In patients with AAS, ET is safe; however, in our study group, the results were not cru‑ cial in making a decision to perform AVR. Patients treated with β‑blockers who did not achieve 85% of predicted maximal heart rate had a higher probability of AVR. The influence of the use of β‑blockers on the decision to perform AVR in this patient population warrants further revision.