Valvular heart diseaseMeta-Analysis of Prognostic Value of Stress Testing in Patients With Asymptomatic Severe Aortic Stenosis
Section snippets
Methods
We conducted a pooled analysis of clinical studies of patients with asymptomatic severe AS who underwent stress testing and in whom outcomes data on cardiac events and referral for AVR were available. Ovid/Medline was used to identify published clinical studies from 1985 through July 2008. Key words used to search included “asymptomatic aortic stenosis” and “stress test” (Figure 1). The search yielded 59 published human clinical studies. The search was further limited to the English language (n
Results
Table 1 lists the study designs, definitions of clinical end points, observed populations, sample sizes, follow-up periods, types of stress testing, and stress protocols used. In particular, there were no differences in age distribution, with a narrow range from 50 to 66 years. However, there was some difference in the follow-up periods, ranging from 11 to 36 months. Three studies used graded bicycle ergomtery,2, 5, 6 while 3 studies used treadmill testing (modified Bruce,4 Ellestad,3 and
Discussion
The most important findings of our meta-analysis are that (1) symptom-limited stress testing is safe in asymptomatic patients with severe AS, (2) normal stress test results predict reduced risk for adverse cardiac events compared to abnormal findings, and (3) no patient with normal stress test results experienced sudden cardiac death. Our analysis consisted of 491 patients with asymptomatic severe AS, in whom there were 9 sudden cardiac deaths and 208 cardiac events. Normal stress test results
References (29)
- et al.
Prediction of symptom-onset in aortic stenosis: a comparison of pressure drop/flow slope and haemodynamic measures at rest
Int J Cardiol
(2001) - et al.
Systemic and left ventricular responses to exercise stress in asymptomatic patients with valvular aortic stenosis
Am J Cardiol
(1991) - et al.
Increased B-type natriuretic peptide is associated with an abnormal blood pressure response to exercise in asymptomatic aortic stenosis
Int J Cardiol
(2008) - et al.
Physiologic changes with maximal exercise in asymptomatic valvular aortic stenosis assessed by Doppler echocardiography
J Am Coll Cardiol
(1992) - et al.
Management of asymptomatic severe aortic stenosis
J Am Coll Cardiol
(2008) - et al.
Prediction of operative mortality after valve replacement surgery
J Am Coll Cardiol
(2001) - et al.
Comparison of outcome of asymptomatic to symptomatic patients older than 20 years of age with valvular aortic stenosis
Am J Cardiol
(1988) - et al.
Malignant natural history of asymptomatic severe aortic stenosis: benefit of aortic valve replacement
Ann Thorac Surg
(2006) - et al.
The benefits of early valve replacement in asymptomatic patients with severe aortic stenosis
J Thorac Cardiovasc Surg
(2008) - et al.
Prospective study of asymptomatic valvular aortic stenosisClinical, echocardiographic, and exercise predictors of outcome
Circulation
(1997)
Value of exercise testing to evaluate the indication for surgery in asymptomatic patients with valvular aortic stenosis
J Heart Valve Dis
Treatment decision in asymptomatic aortic valve stenosis: role of exercise testing
Heart
Exercise testing to stratify risk in aortic stenosis
Eur Heart J
Prognostic importance of quantitative exercise Doppler echocardiography in asymptomatic valvular aortic stenosis
Circulation
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