Saeed Sahrai, Rajani Ronak, Seifert Reinhard, Parkin Denise, Chambers John Boyd
Cardiothoracic Centre, Guy's & St Thomas' Hospital, London, UK.
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Heart. 2018 Nov;104(22):1836-1842. doi: 10.1136/heartjnl-2018-312939. Epub 2018 Apr 13.
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).
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.
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%.
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.
评估中度至重度主动脉瓣狭窄（AS）的明显无症状患者进行跑步机运动试验的安全性和耐受性，以及所揭示症状与预后的相关性。
对316例（年龄65±12岁，67%为男性）中度和重度AS患者进行回顾性队列研究，这些患者在一家专科瓣膜诊所接受了超声心动图检查和改良布鲁斯运动跑步机试验（ETT）。结局指标为主动脉瓣置换术（AVR）、全因死亡率或AVR与全因死亡率的复合指标。
基线时，有210例（66%）中度AS患者和106例（34%）重度AS患者。发生了264例（83%）事件。234例（74%）患者达到了AVR指征，其中145例（69%）中度AS患者和88例（83%）重度AS患者（p<0.05）。在随访期间记录的30例（9%）死亡病例中，20例（67%）与心血管相关。总共进行了797次运动试验（平均每位患者2.5±2.1次）。未观察到严重不良事件。基线ETT时所揭示症状的患病率为29%（n=91），重度AS患者显著高于中度AS患者（38%对23%，p=0.008）。在为期34.9（标准差35.1）个月的随访期间进行的系列ETT中，18%-59%的患者出现了症状。有症状的患者在24个月时的无事件生存率为46%±4%，无症状的患者为70%±4%。
中度或重度AS患者的ETT是安全且可耐受的。系列运动试验有助于揭示病史中未提及的症状，并为基线试验增加预后信息。
