Exercise Echocardiography in Asymptomatic Patients with Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction
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The management of asymptomatic patients with severe aortic stenosis (AS) remains controversial. Recent series reported thatearly aortic valve replacement might be associated with improved clinical outcomes. However, the risk-benefit ratio should becarefully evaluated and early surgery only be proposed to a subset of asymptomatic patients considered at higher risk. Exerciseechocardiography can help unmask symptomatic patients combined with assessment of the hemodynamic consequences of AS. Recent studies have demonstrated that exercise echocardiography can provide incremental prognostic value to identify patientswho may benefit most from early surgery. In “truly” asymptomatic patients, an increase in mean aortic gradient ≥ 18–20 mmHg,a limited left ventricular contractile reserve or a pulmonary hypertension during exercise are predictive parameters of adversecardiac events. Exercise echocardiography is low-cost, safe and available in many referral centers, and does not expose patients toradiation. The purpose of this article is to describe the role of exercise testing and echocardiography in the management ofasymptomatic patients with severe AS and preserved left ventricular ejection fraction.
Abstract
The management of asymptomatic patients with severe aortic stenosis (AS) remains controversial. Recent series reported thatearly aortic valve replacement might be associated with improved clinical outcomes. However, the risk-benefit ratio should becarefully evaluated and early surgery only be proposed to a subset of asymptomatic patients considered at higher risk. Exerciseechocardiography can help unmask symptomatic patients combined with assessment of the hemodynamic consequences of AS. Recent studies have demonstrated that exercise echocardiography can provide incremental prognostic value to identify patientswho may benefit most from early surgery. In “truly” asymptomatic patients, an increase in mean aortic gradient ≥ 18–20 mmHg,a limited left ventricular contractile reserve or a pulmonary hypertension during exercise are predictive parameters of adversecardiac events. Exercise echocardiography is low-cost, safe and available in many referral centers, and does not expose patients toradiation. The purpose of this article is to describe the role of exercise testing and echocardiography in the management ofasymptomatic patients with severe AS and preserved left ventricular ejection fraction.
참고문헌 (26)
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