医学
无症状的
心脏病学
内科学
狭窄
主动脉瓣置换术
主动脉瓣
主动脉瓣狭窄
射血分数
多普勒超声心动图
左心室肥大
心力衰竭
血压
舒张期
作者
Éric Abergel,Clément Venner,Christophe Tribouilloy,Christophe Chauvel,Marc A. Simon,Rébecca Codiat,Thiérry Piéchaud,Vincent Maurin,Edouard Dejour,Ankitha Kumble,Mo Saffarini
标识
DOI:10.1161/jaha.124.036599
摘要
Background The prognostic value of serial exercise echocardiography (EEC) in asymptomatic severe aortic stenosis is unknown. We sought to evaluate the safety and utility of monitoring patients with asymptomatic severe aortic stenosis by annual EECs to refer them to aortic valve replacement (AVR) or to keep them under follow‐up. Methods and Results The cohort comprised 196 patients, with a normal screening EEC and a minimal follow‐up of 18 months. Follow‐up was planned until there was an indication for AVR, based on a resting transthoracic echocardiography at 6 months and then every year, and an EEC at 1 year and then every year (alternating resting transthoracic echocardiography and EEC every 6 months). During follow‐up, patients were referred to AVR if they reported symptoms, if rest transthoracic echocardiography was positive (left ventricular dysfunction, aortic maximal velocity ≥5 m/s, or severe valve calcification with aortic maximal velocity progression ≥0.3 m/s per year) or if EEC was positive (occurrence during exercise of any aortic stenosis‐related symptoms, significant ventricular arrhythmias, a drop or an insufficient rise (<20 mm Hg) in systolic blood pressure from baseline, or a left ventricular dysfunction). Among the 196 patients (76% men, aged 76.1±11.1 years), a mean 2.85±1.22 EECs were conducted. There were no serious complications during any of the EECs. Each serial transthoracic echocardiography at rest and each EEC yielded 0%–22% and 23.5%–50% of positive results, respectively, leading to AVR. We delayed AVR by a mean of 2.93±1.95 years after the screening EEC. No cardiac‐related death or sudden death was reported during the study. Conclusions Our findings demonstrate the safety and prognostic utility of serial EECs in the management of patients with asymptomatic severe aortic stenosis to guide timely AVR.
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