Objectives This study sought to evaluate the prognostic value of mean pressure gradient (MPG) increase and peak systolic pulmonary artery pressure (SPAP) measured during exercise stress echocardiography in asymptomatic patients with aortic stenosis (AS).

Background Exercise testing is recommended in asymptomatic AS patients, but the additional value of exercise-stress echocardiography, especially the prognostic value of MPG increase and peak SPAP, is still debated.

Methods We enrolled all consecutive patients with pure, isolated, asymptomatic AS and preserved ejection fraction ≥50% and normal SPAP (<50 mm Hg) who underwent symptom-limited exercise echocardiography at our institution. Occurrence of AS-related events (symptoms or congestive heart failure) or occurrence of aortic valve replacement was recorded.

Results We enrolled 148 patients (66 ± 15 years of age; 74% males; MPG: 47 ± 13 mm Hg; SPAP: 34 ± 6 mm Hg). No complications were observed. Thirty-six patients (24%) had an abnormal exercise test result (occurrence of symptoms, fall in blood pressure, and/or ST-segment depression) and were referred for surgery. Among the 112 patients with a normal exercise test result, 38 patients (34%) had abnormal exercise echocardiography scores (MPG increase >20 mm Hg and/or SPAP at peak exercise >60 mm Hg). These 112 patients were managed conservatively. During a mean follow-up of 14 ± 8 months, an AS-related event occurred in 30 patients, and 25 patients underwent surgery. Neither MPG increase >20 mm Hg nor peak SPAP >60 mm Hg was predictive of occurrence of AS-related events or aortic valve replacement (all p > 0.20). In contrast, baseline AS severity was an important prognostic factor (all p < 0.01).

Conclusions In this observational study including 148 patients with asymptomatic AS, we confirmed and extended the importance of exercise testing for unveiling functional limitation. More importantly, neither the increase in MPG nor in SPAP at peak exercise was predictive of outcome. Our results do not support the use of these parameters in risk-stratification and clinical management of asymptomatic AS patients.

目的本研究旨在评估无症状主动脉瓣狭窄（AS）患者在运动负荷超声心动图期间测得的平均压力梯度（MPG）增加和收缩期肺动脉高压峰值（SPAP）的预后价值。

背景技术建议在无症状的AS患者中进行运动测试，但是运动负荷超声心动图的附加价值，尤其是MPG升高和SPAP峰值的预后价值仍存在争议。

方法我们招募了所有连续，纯净的，孤立的，无症状的AS且射血分数≥50％且SPAP正常（<50 mm Hg）且接受了症状受限运动超声心动图检查的患者。记录与AS相关的事件（症状或充血性心力衰竭）的发生或主动脉瓣置换的发生。

结果我们招募了148例患者（66±15岁; 74％男性; MPG：47±13 mm Hg; SPAP：34±6 mm Hg）。没有观察到并发症。三十六名患者（24％）的运动测试结果异常（出现症状，血压下降和/或ST段压低），并被转诊接受手术。在112例运动测试结果正常的患者中，有38例（34％）的运动超声心动图评分异常（MPG增加> 20 mm Hg和/或峰值运动> 60 mm Hg时的SPAP）。这112例患者保守治疗。在平均随访14±8个月期间，有30例患者发生了AS相关事件，其中25例接受了手术。MPG增加> 20 mm Hg和峰值SPAP> 60 mm Hg均不能预测AS相关事件的发生或主动脉瓣置换的发生（所有p> 0.20）。相比之下，

结论在这项包括148例无症状AS患者的观察性研究中，我们确认并扩展了运动测试对于揭示功能受限的重要性。更重要的是，高峰运动时MPG或SPAP的增加均不能预测结果。我们的结果不支持在无症状AS患者的风险分层和临床管理中使用这些参数。