Department of Cardiology, University of Liège, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium.
Curr Opin Cardiol. 2013 Sep;28(5):531-9. doi: 10.1097/HCO.0b013e3283632b41.
The emerging role of exercise and especially exercise echocardiography in aortic stenosis has been recently emphasized. In this clinical setting, stress testing can help identify patients who are falsely asymptomatic, unmask those who will rapidly become symptomatic and appraise the true haemodynamic consequences of aortic stenosis.
Both exercise stress test and exercise stress echocardiography are strictly contraindicated in symptomatic patients. In contrast, exercise testing is recommended by current guidelines in asymptomatic patients with aortic stenosis. During exercise, either the development of symptoms or an abnormal blood pressure response is associated with a poor outcome and should be considered as an indication for surgery. Exercise echocardiography permits stratification and identification of asymptomatic patients at a higher risk of a cardiac event: exercise-induced increase of more than 18-20 mmHg in mean pressure gradient, absence of left ventricular contractile reserve and/or exercise pulmonary hypertension are suggestive features of an advanced disease process.
Exercise echocardiography has the advantage of its wide availability, low cost and versatility. In asymptomatic severe aortic stenosis, exercise echocardiography can help unmask patients at a more advanced stage of the disease and could aid in identifying those who may benefit from an early elective aortic valve surgery.
运动及运动超声心动图在主动脉瓣狭窄中的作用越来越受到重视。在这种临床情况下，压力测试可以帮助识别那些假性无症状的患者，发现那些将迅速出现症状的患者，并评估主动脉瓣狭窄的真实血液动力学后果。
有症状的患者应严格禁止进行运动负荷试验和运动超声心动图检查。相反，目前的指南建议在无症状的主动脉瓣狭窄患者中进行运动测试。在运动过程中，出现症状或血压反应异常与预后不良相关，应被视为手术的指征。运动超声心动图可对无症状患者进行分层，并识别出更高风险的心脏事件的患者：平均压力梯度增加超过 18-20mmHg、左心室收缩储备缺失和/或运动性肺动脉高压是疾病进展的提示性特征。
运动超声心动图具有广泛应用、成本低和多功能的优点。在无症状的严重主动脉瓣狭窄患者中，运动超声心动图可以帮助发现处于疾病更晚期的患者，并有助于识别那些可能受益于早期选择性主动脉瓣手术的患者。
