Cardiopulmonary exercise testing prognostic in aortic stenosis
(HealthDay)—For patients judged as symptomatic or questionably symptomatic for aortic stenosis, an initially conservative management strategy results in good prognosis if cardiopulmonary exercise testing (CPET) does not indicate significant hemodynamic compromise, according to a study published in the Sept. 1 issue of The American Journal of Cardiology.
Van D. Le, Ph.D., from Roskilde University Hospital in Denmark, and colleagues examined whether CPET is prognostically useful for patients judged asymptomatic or questionably symptomatic for aortic stenosis with aortic valve area index <0.6 cm²/m² and left ventricular ejection fraction ≥0.50. Participants were managed conservatively if they had normal peak oxygen consumption and peak oxygen pulse (group 1) or subnormal peak oxygen consumption or peak oxygen pulse with CPET data indicating pathologies other than hemodynamic compromise from aortic stenosis (group 2).
One hundred one patients were included (median age, 75 years) and 67 percent were judged as questionably symptomatic. The researchers found that the rates of unexpected cardiac death and unexpected hospitalization with heart failure were 0 and 6.0 percent, respectively, at a follow-up of 24 ± 6 months. All-cause mortality was 4 percent, relative to 8.0 percent in a population matched for age and gender. For groups 1 and 2, 37.1 and 38.7 percent, respectively, succumbed to cardiac death, or were hospitalized for heart failure, or underwent valve replacement.
"In conclusion, if CPET does not indicate a significant hemodynamic compromise because of aortic stenosis, an initially conservative strategy results in a good prognosis and an acceptable event rate," the authors write.
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