Abergel Eric, Venner Clement, Tribouilloy Christophe, Chauvel Christophe, Simon Marc, Codiat Rébecca, Piechaud Thierry, Maurin Vincent
Elsan Group, Clinique Saint Augustin Bordeaux France.
Department of Cardiology Amiens University Hospital Amiens France.
J Am Heart Assoc. 2025 Jan 7;14(1):e036599. doi: 10.1161/JAHA.124.036599. Epub 2024 Dec 20.
The prognostic value of serial exercise echocardiography (EEC) in asymptomatic severe aortic stenosis is unknown. We sought to evaluate the safety and utility of monitoring patients with asymptomatic severe aortic stenosis by annual EECs to refer them to aortic valve replacement (AVR) or to keep them under follow-up.
The cohort comprised 196 patients, with a normal screening EEC and a minimal follow-up of 18 months. Follow-up was planned until there was an indication for AVR, based on a resting transthoracic echocardiography at 6 months and then every year, and an EEC at 1 year and then every year (alternating resting transthoracic echocardiography and EEC every 6 months). During follow-up, patients were referred to AVR if they reported symptoms, if rest transthoracic echocardiography was positive (left ventricular dysfunction, aortic maximal velocity ≥5 m/s, or severe valve calcification with aortic maximal velocity progression ≥0.3 m/s per year) or if EEC was positive (occurrence during exercise of any aortic stenosis-related symptoms, significant ventricular arrhythmias, a drop or an insufficient rise (<20 mm Hg) in systolic blood pressure from baseline, or a left ventricular dysfunction). Among the 196 patients (76% men, aged 76.1±11.1 years), a mean 2.85±1.22 EECs were conducted. There were no serious complications during any of the EECs. Each serial transthoracic echocardiography at rest and each EEC yielded 0%-22% and 23.5%-50% of positive results, respectively, leading to AVR. We delayed AVR by a mean of 2.93±1.95 years after the screening EEC. No cardiac-related death or sudden death was reported during the study.
Our findings demonstrate the safety and prognostic utility of serial EECs in the management of patients with asymptomatic severe aortic stenosis to guide timely AVR.
连续运动超声心动图（EEC）在无症状重度主动脉瓣狭窄中的预后价值尚不清楚。我们旨在评估通过每年进行EEC监测无症状重度主动脉瓣狭窄患者的安全性和实用性，以便将他们转诊至主动脉瓣置换术（AVR）或继续进行随访。
该队列包括196例患者，筛查EEC正常，最短随访18个月。计划随访至有AVR指征，基于6个月时的静息经胸超声心动图，之后每年进行一次，以及1年时的EEC，之后每年进行一次（每6个月交替进行静息经胸超声心动图和EEC）。在随访期间，如果患者出现症状、静息经胸超声心动图阳性（左心室功能障碍、主动脉最大流速≥5 m/s，或严重瓣膜钙化且主动脉最大流速每年进展≥0.3 m/s）或EEC阳性（运动期间出现任何与主动脉瓣狭窄相关的症状、显著室性心律失常、收缩压较基线下降或升高不足（<20 mmHg），或左心室功能障碍），则将其转诊至AVR。在196例患者（76%为男性，年龄76.1±11.1岁）中，平均进行了2.85±1.22次EEC。在任何一次EEC期间均未出现严重并发症。每次静息经胸超声心动图和每次EEC分别产生0%-22%和23.5%-50%的阳性结果，导致进行AVR。在筛查EEC后，我们将AVR平均推迟了2.93±1.95年。研究期间未报告心脏相关死亡或猝死。
我们的研究结果表明，连续EEC在无症状重度主动脉瓣狭窄患者的管理中具有安全性和预后实用性，可指导及时进行AVR。
