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European Journal of Echocardiography Advance Access published online on May 20, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen163
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Argument for a Doppler echocardiography during exercise in assessing asymptomatic patients with severe aortic stenosis

Guillaume Leurent1,{dagger}, Erwan Donal1,*,{dagger}, Christian de Place1, Céline Chabanne1, Renaud Gervais1, Claire Fougerou2, Alain le Helloco1, Jean-Claude Daubert1, Philippe Mabo1 and Marcel Laurent1

1 Département de Cardiologie et Maladies Vasculaires, Centre Cardio-Pneumologique, CHU Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes Cedex, France
2 Centre d’Investigation Clinique, INSERM 0203, CHU Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes Cedex, France

Received 3 February 2008; accepted after revision 12 April 2008.

* Corresponding author. Tel: +33 2 99 28 25 25; fax: +33 2 99 28 25 10.E-mail address: erwan.donal{at}chu-rennes.fr


  Abstract

Aims: Exercise stress testing (EST) is recommended by guidelines to risk-stratify patients with asymptomatic valvular aortic stenosis (AS), though the role of quantitative exercise-Doppler echocardiography has rarely been studied. This prospective study sought to correlate standard EST results with the haemodynamic measurements made during exercise by Doppler echocardiography.

Methods and results: We performed rest and semi-supine exercise Doppler echocardiography in 44 consecutive patients (mean age = 68 ± 12 years) with aortic valve areas ≤0.6 cm2/m2. The effective aortic valve area (EOA), cardiac output (CO), maximal transvalvular velocity, and pulmonary pressure were monitored over the test. No serious adverse event was observed. EST was positive in 26 (Group 1) and negative in 18 (Group 2) patients. Baseline echocardiographic measurements were similar (EOA 0.77 ± 0.15 vs. 0.78 ± 0.14 cm2; CO 5.5 ± 1.6 vs. 5.9 ± 2 L/min) in both groups. Exercise-induced changes in CO (+2.9 ± 2 vs. +4.3 ± 1.8 L/min, P = 0.04) and EOA (–0.04 ± 0.18 vs. +0.15 ± 0.24 cm2, P = 0.015) were significantly greater in Group 2. A correlation between changes in EOA and changes in CO during exercise was observed, but significantly higher in Group 2 (P = 0.04).

Conclusion: In the presence of severe asymptomatic AS, exercise Doppler echocardiography, assessing the mechanisms behind a positive EST, appears very promising but further studies with prognosis assessment remain necessary.

Keywords: Aortic valve stenosis; Exercise stress test; Doppler echocardiography

{dagger} The first two authors contributed equally.


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