Ennezat P V, Maréchaux S, Iung B, Chauvel C, LeJemtel T H, Pibarot P
Cardiology Hospital, Intensive Care Unit, Lille Cedex, France.
Heart. 2009 Jun;95(11):877-84. doi: 10.1136/hrt.2008.150011. Epub 2008 Sep 23.
Management of asymptomatic patients with severe aortic valve stenosis (AVS) remains a source of debate. Exercise testing is no longer contraindicated and needs now to be considered when evaluating asymptomatic patients with AVS. Several studies have clearly demonstrated that exercise-elicited symptoms during conventional upright exercise portends clinical events. Semi-supine exercise with continuous Doppler echocardiography monitoring elicits cardiovascular abnormalities that are not detected at rest. Abnormal left ventricular response to exercise and/or major increase in mean transvalvular gradient add to the prognostic value of elicited symptoms in asymptomatic patients with severe AVS. However, preliminary experience needs to be confirmed to warrant routine use of exercise Doppler echocardiography in the evaluation of patients with asymptomatic AVS.
无症状重度主动脉瓣狭窄（AVS）患者的管理仍是一个有争议的问题。运动试验不再是禁忌，现在在评估无症状AVS患者时需要考虑。多项研究已明确表明，传统直立运动期间运动诱发的症状预示着临床事件。半卧位运动并持续进行多普勒超声心动图监测可诱发静息时未检测到的心血管异常。左心室对运动的异常反应和/或平均跨瓣压差的大幅增加增加了无症状重度AVS患者诱发症状的预后价值。然而，初步经验需要得到证实，才能保证在无症状AVS患者评估中常规使用运动多普勒超声心动图。
