Prognostic Value and Safety of Serial Exercise Echocardiography in Asymptomatic Severe Aortic Stenosis
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 the...
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| Veröffentlicht in: | Journal of the American Heart Association 2025-01, Vol.14 (1), p.e036599 |
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| creator | Abergel, Eric Venner, Clement Tribouilloy, Christophe Chauvel, Christophe Simon, Marc Codiat, Rébecca Piechaud, Thierry Maurin, Vincent |
| description | 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 ( |
| doi_str_mv | 10.1161/JAHA.124.036599 |
| format | Article |
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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.</description><identifier>ISSN: 2047-9980</identifier><identifier>EISSN: 2047-9980</identifier><identifier>DOI: 10.1161/JAHA.124.036599</identifier><identifier>PMID: 39704221</identifier><language>eng</language><publisher>England: Wiley-Blackwell</publisher><subject>Aged ; Aged, 80 and over ; Aortic Valve - diagnostic imaging ; Aortic Valve - physiopathology ; Aortic Valve - surgery ; Aortic Valve Stenosis - diagnostic imaging ; Aortic Valve Stenosis - physiopathology ; Aortic Valve Stenosis - surgery ; Asymptomatic Diseases ; Cardiology and cardiovascular system ; Echocardiography, Stress - methods ; Female ; Heart Valve Prosthesis Implantation - adverse effects ; Human health and pathology ; Humans ; Life Sciences ; Male ; Predictive Value of Tests ; Prognosis ; Severity of Illness Index ; Time Factors</subject><ispartof>Journal of the American Heart Association, 2025-01, Vol.14 (1), p.e036599</ispartof><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c1301-8df70e9ac77d7e40ea231303ddc19b6cd101cf85b9e6976dd6bd93844377c1473</cites><orcidid>0000-0002-4269-7083 ; 0000-0002-2742-145X ; 0000-0001-7867-3668 ; 0009-0009-2021-0412</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,778,782,862,883,27913,27914</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39704221$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://u-picardie.hal.science/hal-04862597$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Abergel, Eric</creatorcontrib><creatorcontrib>Venner, Clement</creatorcontrib><creatorcontrib>Tribouilloy, Christophe</creatorcontrib><creatorcontrib>Chauvel, Christophe</creatorcontrib><creatorcontrib>Simon, Marc</creatorcontrib><creatorcontrib>Codiat, Rébecca</creatorcontrib><creatorcontrib>Piechaud, Thierry</creatorcontrib><creatorcontrib>Maurin, Vincent</creatorcontrib><creatorcontrib>ReSurg 3</creatorcontrib><title>Prognostic Value and Safety of Serial Exercise Echocardiography in Asymptomatic Severe Aortic Stenosis</title><title>Journal of the American Heart Association</title><addtitle>J Am Heart Assoc</addtitle><description>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.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Valve - diagnostic imaging</subject><subject>Aortic Valve - physiopathology</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Stenosis - diagnostic imaging</subject><subject>Aortic Valve Stenosis - physiopathology</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Asymptomatic Diseases</subject><subject>Cardiology and cardiovascular system</subject><subject>Echocardiography, Stress - methods</subject><subject>Female</subject><subject>Heart Valve Prosthesis Implantation - adverse effects</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Severity of Illness Index</subject><subject>Time Factors</subject><issn>2047-9980</issn><issn>2047-9980</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkcFPwyAUh4nR6DI9ezMc9bANCi3l2CzTaZZoMvVKGLw6TDsmdIv772VOjbwD8Pjed-CH0CUlQ0oLOnqoptWQZnxIWJFLeYR6GeFiIGVJjv-dz9BFjO8krSITLJen6IxJQXiW0R6qn4J_W_nYOYNfdbMBrFcWz3UN3Q77Gs8hON3gyScE4yLgiVl6o4N1_i3o9XKH3QpXcdeuO9_qvWQOWwiAKx--bx0kuYvn6KTWTYSLn72PXm4nz-PpYPZ4dz-uZgNDGaGD0taCgNRGCCuAE9AZSw_MWkPlojCWEmrqMl9IKKQorC0WVrKScyaEoVywPro5eJe6UevgWh12ymunptVM7XuEl0WWS7Glib0-sOvgPzYQO9W6aKBp9Ar8JiqWhLzMUyV0dEBN8DEGqP_clKh9FmqfhUpZqEMWaeLqR75ZtGD_-N-fZ1_mhIO3</recordid><startdate>20250107</startdate><enddate>20250107</enddate><creator>Abergel, Eric</creator><creator>Venner, Clement</creator><creator>Tribouilloy, Christophe</creator><creator>Chauvel, Christophe</creator><creator>Simon, Marc</creator><creator>Codiat, Rébecca</creator><creator>Piechaud, Thierry</creator><creator>Maurin, Vincent</creator><general>Wiley-Blackwell</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0002-4269-7083</orcidid><orcidid>https://orcid.org/0000-0002-2742-145X</orcidid><orcidid>https://orcid.org/0000-0001-7867-3668</orcidid><orcidid>https://orcid.org/0009-0009-2021-0412</orcidid></search><sort><creationdate>20250107</creationdate><title>Prognostic Value and Safety of Serial Exercise Echocardiography in Asymptomatic Severe Aortic Stenosis</title><author>Abergel, Eric ; Venner, Clement ; Tribouilloy, Christophe ; Chauvel, Christophe ; Simon, Marc ; Codiat, Rébecca ; Piechaud, Thierry ; Maurin, Vincent</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1301-8df70e9ac77d7e40ea231303ddc19b6cd101cf85b9e6976dd6bd93844377c1473</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Valve - diagnostic imaging</topic><topic>Aortic Valve - physiopathology</topic><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Stenosis - diagnostic imaging</topic><topic>Aortic Valve Stenosis - physiopathology</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Asymptomatic Diseases</topic><topic>Cardiology and cardiovascular system</topic><topic>Echocardiography, Stress - methods</topic><topic>Female</topic><topic>Heart Valve Prosthesis Implantation - adverse effects</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Severity of Illness Index</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abergel, Eric</creatorcontrib><creatorcontrib>Venner, Clement</creatorcontrib><creatorcontrib>Tribouilloy, Christophe</creatorcontrib><creatorcontrib>Chauvel, Christophe</creatorcontrib><creatorcontrib>Simon, Marc</creatorcontrib><creatorcontrib>Codiat, Rébecca</creatorcontrib><creatorcontrib>Piechaud, Thierry</creatorcontrib><creatorcontrib>Maurin, Vincent</creatorcontrib><creatorcontrib>ReSurg 3</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Journal of the American Heart Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abergel, Eric</au><au>Venner, Clement</au><au>Tribouilloy, Christophe</au><au>Chauvel, Christophe</au><au>Simon, Marc</au><au>Codiat, Rébecca</au><au>Piechaud, Thierry</au><au>Maurin, Vincent</au><aucorp>ReSurg 3</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic Value and Safety of Serial Exercise Echocardiography in Asymptomatic Severe Aortic Stenosis</atitle><jtitle>Journal of the American Heart Association</jtitle><addtitle>J Am Heart Assoc</addtitle><date>2025-01-07</date><risdate>2025</risdate><volume>14</volume><issue>1</issue><spage>e036599</spage><pages>e036599-</pages><issn>2047-9980</issn><eissn>2047-9980</eissn><abstract>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.</abstract><cop>England</cop><pub>Wiley-Blackwell</pub><pmid>39704221</pmid><doi>10.1161/JAHA.124.036599</doi><orcidid>https://orcid.org/0000-0002-4269-7083</orcidid><orcidid>https://orcid.org/0000-0002-2742-145X</orcidid><orcidid>https://orcid.org/0000-0001-7867-3668</orcidid><orcidid>https://orcid.org/0009-0009-2021-0412</orcidid></addata></record> |
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| subjects | Aged Aged, 80 and over Aortic Valve - diagnostic imaging Aortic Valve - physiopathology Aortic Valve - surgery Aortic Valve Stenosis - diagnostic imaging Aortic Valve Stenosis - physiopathology Aortic Valve Stenosis - surgery Asymptomatic Diseases Cardiology and cardiovascular system Echocardiography, Stress - methods Female Heart Valve Prosthesis Implantation - adverse effects Human health and pathology Humans Life Sciences Male Predictive Value of Tests Prognosis Severity of Illness Index Time Factors |
| title | Prognostic Value and Safety of Serial Exercise Echocardiography in Asymptomatic Severe Aortic Stenosis |
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