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Background <p>Patients with moderate aortic stenosis (AS) may experience symptoms and adverse outcomes. The aim of this study was to determine whether patients with moderate AS exhibited objective evidence of exercise limitation, compared with age and sex matched controls and if so, to determine which echocardiographic parameters predicted exercise ability.</p> Methods <p>This was a prospective case control study of patients with moderate AS (peak velocity (Vmax) 3.0–3.9&#xa0;m/s, mean gradient (MG) 20-39mmHg, aortic valve area (AVA)1.1-1.5cm<sup>2</sup> ) and left ventricular ejection fraction (LVEF) ≥ 55%. All patients underwent cardiopulmonary stress echocardiography.</p> Results <p>25 patients with moderate AS (Vmax 3.5 ± 0.2mmHg, mean gradient 28 ± 5mmHg, AVA 1.2 ± 0.1cm<sup>2</sup>, LVEF 61 ± 4%) were compared with 25 controls. % predicted oxygen uptake efficiency slope (OUES), % predicted O<sub>2</sub> pulse and VO<sub>2</sub> at anaerobic threshold (AT) were significantly lower in patients compared with controls (OUES 79 ± 15 vs. 89 ± 15%, <i>p</i> = 0.013). VO<sub>2</sub> did not significantly differ between cases and controls.</p> Conclusion <p>Objective measures of exercise capacity including OUES, O<sub>2</sub> pulse and VO<sub>2</sub> at AT are significantly lower in patients with moderate AS compared with controls, suggesting that these parameters may be more useful than VO<sub>2</sub> where patients may be unable to complete a maximal exercise test. Risk stratification using cardiopulmonary exercise echocardiography may help to identify patients with moderate AS who are at increased risk of cardiovascular events and should be considered for more intensive surveillance and intervention.</p> Trial registration <p>Clinical trial number MRC 0225 IRAS 207395.</p>

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Exercise capacity in moderate aortic stenosis: a cardiopulmonary stress echocardiography study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月5日

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  • Sveeta Badiani,
  • Jet van Zalen,
  • Sahar Alborikan,
  • Aeshah Althunayyan,
  • David Bruce,
  • Thomas Treibel,
  • Sanjeev Bhattacharyya,
  • Nikhil Patel,
  • Guy Lloyd

摘要

Background

Patients with moderate aortic stenosis (AS) may experience symptoms and adverse outcomes. The aim of this study was to determine whether patients with moderate AS exhibited objective evidence of exercise limitation, compared with age and sex matched controls and if so, to determine which echocardiographic parameters predicted exercise ability.

Methods

This was a prospective case control study of patients with moderate AS (peak velocity (Vmax) 3.0–3.9 m/s, mean gradient (MG) 20-39mmHg, aortic valve area (AVA)1.1-1.5cm2 ) and left ventricular ejection fraction (LVEF) ≥ 55%. All patients underwent cardiopulmonary stress echocardiography.

Results

25 patients with moderate AS (Vmax 3.5 ± 0.2mmHg, mean gradient 28 ± 5mmHg, AVA 1.2 ± 0.1cm2, LVEF 61 ± 4%) were compared with 25 controls. % predicted oxygen uptake efficiency slope (OUES), % predicted O2 pulse and VO2 at anaerobic threshold (AT) were significantly lower in patients compared with controls (OUES 79 ± 15 vs. 89 ± 15%, p = 0.013). VO2 did not significantly differ between cases and controls.

Conclusion

Objective measures of exercise capacity including OUES, O2 pulse and VO2 at AT are significantly lower in patients with moderate AS compared with controls, suggesting that these parameters may be more useful than VO2 where patients may be unable to complete a maximal exercise test. Risk stratification using cardiopulmonary exercise echocardiography may help to identify patients with moderate AS who are at increased risk of cardiovascular events and should be considered for more intensive surveillance and intervention.

Trial registration

Clinical trial number MRC 0225 IRAS 207395.