Department of Acquired Cardiac Defects, National Institute of Cardiology, Warsaw, Poland.
1st Department of Heart Rhythm Disorders, National Institute of Cardiology, Warsaw, Poland
Pol Arch Intern Med. 2021 Apr 29;131(4):332-338. doi: 10.20452/pamw.15873. Epub 2021 Mar 15.
Aortic valve replacement (AVR) is recommended for symptomatic patients with severe aortic stenosis (AS). In asymptomatic AS (AAS), exercise testing (ET) is recommended; however, it remains controversial.
The aim of our study was to assess the importance of ET in patients with AAS.
A total of 89 patients with AAS (53 men; mean [SD] age, 59.5 [11.7] years) underwent 244 symptom‑limited ETs.
All ETs were clinically negative. During the median (interquartile range) follow‑up of 22 (12) months, 39 patients (22 men) developed symptoms (the AVR group). This group was compared with 50 asymptomatic non‑AVR patients. In the multivariable Cox analysis, the maximal heart rate during ET less than 85% of age- and sex-adjusted maximal predicted heart rate (THR less than 85%) was related to AVR (P = 0.01). After adjusting for the use of β‑blockers, this was not significant (P = 0.08). In the β‑blocker subgroup, the THR less than 85% was significantly related to AVR in the univariable Cox analysis (hazard ratio, 2.2; 95% CI, 1.07-4.9; P = 0.03) and after adjusting for age (P = 0.047). This relationship was not observed in patients who did not receive β‑blockers.
In patients with AAS, ET is safe; however, in our study group, the results were not cru‑ cial in making a decision to perform AVR. Patients treated with β‑blockers who did not achieve 85% of predicted maximal heart rate had a higher probability of AVR. The influence of the use of β‑blockers on the decision to perform AVR in this patient population warrants further revision.
主动脉瓣置换术（AVR）推荐用于有严重主动脉瓣狭窄（AS）症状的患者。在无症状性 AS（AAS）中，推荐进行运动试验（ET）；然而，这仍然存在争议。
我们的研究旨在评估 ET 在 AAS 患者中的重要性。
共有 89 例 AAS 患者（53 名男性；平均[SD]年龄，59.5[11.7]岁）进行了 244 次症状限制的 ET。
所有 ET 均为临床阴性。在中位数（四分位距）22（12）个月的随访期间，39 例患者（22 名男性）出现症状（AVR 组）。该组与 50 例无症状非 AVR 患者进行比较。在多变量 Cox 分析中，ET 时最大心率低于年龄和性别校正后的最大预测心率（THR）的 85%（THR<85%）与 AVR 相关（P=0.01）。在调整β受体阻滞剂的使用后，这一结果不再显著（P=0.08）。在β受体阻滞剂亚组中，在单变量 Cox 分析中，THR<85%与 AVR 显著相关（危险比，2.2；95%CI，1.07-4.9；P=0.03），且在调整年龄后（P=0.047）也显著相关。在未接受β受体阻滞剂治疗的患者中未观察到这种关系。
在 AAS 患者中，ET 是安全的；然而，在我们的研究组中，结果对于决定进行 AVR 并不关键。未达到预测最大心率 85%的β受体阻滞剂治疗患者进行 AVR 的可能性更高。β受体阻滞剂的使用对该患者人群进行 AVR 的决策的影响需要进一步修正。
