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Exercise testing in patients with asymptomatic moderate or severe aortic stenosis

OBJECTIVE: To assess the safety and tolerability of treadmill exercise testing and the association of revealed symptoms with outcome in apparently asymptomatic patients with moderate to severe aortic stenosis (AS). METHODS: A retrospective cohort study of 316 patients (age 65±12 years, 67% men) with...

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Autores principales: Saeed, Sahrai, Rajani, Ronak, Seifert, Reinhard, Parkin, Denise, Chambers, John Boyd
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241614/
https://www.ncbi.nlm.nih.gov/pubmed/29654094
http://dx.doi.org/10.1136/heartjnl-2018-312939
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author Saeed, Sahrai
Rajani, Ronak
Seifert, Reinhard
Parkin, Denise
Chambers, John Boyd
author_facet Saeed, Sahrai
Rajani, Ronak
Seifert, Reinhard
Parkin, Denise
Chambers, John Boyd
author_sort Saeed, Sahrai
collection PubMed
description OBJECTIVE: To assess the safety and tolerability of treadmill exercise testing and the association of revealed symptoms with outcome in apparently asymptomatic patients with moderate to severe aortic stenosis (AS). METHODS: A retrospective cohort study of 316 patients (age 65±12 years, 67% men) with moderate and severe AS who underwent echocardiography and modified Bruce exercise treadmill tests (ETTs) at a specialist valve clinic. The outcome measures were aortic valve replacement (AVR), all-cause mortality or a composite of AVR and all-cause mortality. RESULTS: At baseline, there were 210 (66%) patients with moderate and 106 (34%) with severe AS. There were 264 (83%) events. 234 (74%) patients reached an indication for AVR, 145 (69%) with moderate and 88 (83%) with severe AS (p<0.05). Of the 30 (9%) deaths recoded during follow-up, 20 (67%) were cardiovascular related. In total, 797 exercise tests (mean 2.5±2.1 per patient) were performed. No serious adverse events were observed. The prevalence of revealed symptoms at baseline ETT was 29% (n=91) and was significantly higher in severe AS compared with moderate AS (38%vs23%, p=0.008). Symptoms were revealed in 18%–59% of patients during serial ETT conducted over a follow-up period of 34.9 (SD 35.1) months. The event-free survival at 24 months with revealed symptoms was 46%±4% and without revealed symptoms was 70%±4%. CONCLUSIONS: ETT in patients with moderate or severe AS is safe and tolerable. Serial exercise testing is useful to reveal symptoms not volunteered on the history and adds incremental prognostic information to baseline testing.
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spelling pubmed-62416142018-11-27 Exercise testing in patients with asymptomatic moderate or severe aortic stenosis Saeed, Sahrai Rajani, Ronak Seifert, Reinhard Parkin, Denise Chambers, John Boyd Heart Valvular Heart Disease OBJECTIVE: To assess the safety and tolerability of treadmill exercise testing and the association of revealed symptoms with outcome in apparently asymptomatic patients with moderate to severe aortic stenosis (AS). METHODS: A retrospective cohort study of 316 patients (age 65±12 years, 67% men) with moderate and severe AS who underwent echocardiography and modified Bruce exercise treadmill tests (ETTs) at a specialist valve clinic. The outcome measures were aortic valve replacement (AVR), all-cause mortality or a composite of AVR and all-cause mortality. RESULTS: At baseline, there were 210 (66%) patients with moderate and 106 (34%) with severe AS. There were 264 (83%) events. 234 (74%) patients reached an indication for AVR, 145 (69%) with moderate and 88 (83%) with severe AS (p<0.05). Of the 30 (9%) deaths recoded during follow-up, 20 (67%) were cardiovascular related. In total, 797 exercise tests (mean 2.5±2.1 per patient) were performed. No serious adverse events were observed. The prevalence of revealed symptoms at baseline ETT was 29% (n=91) and was significantly higher in severe AS compared with moderate AS (38%vs23%, p=0.008). Symptoms were revealed in 18%–59% of patients during serial ETT conducted over a follow-up period of 34.9 (SD 35.1) months. The event-free survival at 24 months with revealed symptoms was 46%±4% and without revealed symptoms was 70%±4%. CONCLUSIONS: ETT in patients with moderate or severe AS is safe and tolerable. Serial exercise testing is useful to reveal symptoms not volunteered on the history and adds incremental prognostic information to baseline testing. BMJ Publishing Group 2018-11 2018-04-13 /pmc/articles/PMC6241614/ /pubmed/29654094 http://dx.doi.org/10.1136/heartjnl-2018-312939 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Valvular Heart Disease
Saeed, Sahrai
Rajani, Ronak
Seifert, Reinhard
Parkin, Denise
Chambers, John Boyd
Exercise testing in patients with asymptomatic moderate or severe aortic stenosis
title Exercise testing in patients with asymptomatic moderate or severe aortic stenosis
title_full Exercise testing in patients with asymptomatic moderate or severe aortic stenosis
title_fullStr Exercise testing in patients with asymptomatic moderate or severe aortic stenosis
title_full_unstemmed Exercise testing in patients with asymptomatic moderate or severe aortic stenosis
title_short Exercise testing in patients with asymptomatic moderate or severe aortic stenosis
title_sort exercise testing in patients with asymptomatic moderate or severe aortic stenosis
topic Valvular Heart Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241614/
https://www.ncbi.nlm.nih.gov/pubmed/29654094
http://dx.doi.org/10.1136/heartjnl-2018-312939
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