BACKGROUND The optimal management of asymptomatic aortic stenosis (AS) remains controversial. Although exercise stress echocardiography (ESE) has been applied to nonischemic heart disease, the evidence of the prognostic value for asymptomatic AS has been limited. This study aimed to investigate the value of ESE in patients with asymptomatic AS. METHODS This retrospective observational study included consecutive asymptomatic patients with at least moderate AS (mean pressure gradient ≥ 20 mm Hg or aortic valve area < 1.5 cm2) and preserved left ventricular ejection fraction (≥50%) who underwent ESE. Of these, 10 patients who were referred for aortic valve replacement without symptoms were excluded. A final 99 conservatively managed patients (73 ± 13 years; 54% male) were enrolled in this study. All patients were followed for AS-related events. RESULTS During the mean follow-up period of 14 ± 11 months, 23 patients underwent from AS-related events. Although no differences were found between the patients with and without adverse events in terms of mean pressure gradient during exercise, the transvalvular flow rate during exercise (Ex-FR) was lower in the patients who experienced adverse events (236 ± 55 vs 274 ± 64 mL/sec, P = .01). Multivariate Cox regression analysis showed a decrease in Ex-FR (<270 mL/sec) independently associated with adverse events in patients with asymptomatic AS (hazard ratio = 3.53, P < .01). CONCLUSIONS The result of the present study suggests that Ex-FR measured by ESE could play a crucial role in the risk stratification of patients with asymptomatic AS.

中文翻译：

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无症状主动脉瓣狭窄患者运动时跨瓣流速的价值。

背景 无症状主动脉瓣狭窄 (AS) 的最佳管理仍然存在争议。尽管运动负荷超声心动图 (ESE) 已应用于非缺血性心脏病，但无症状 AS 预后价值的证据有限。本研究旨在探讨 ESE 在无症状 AS 患者中的价值。方法 这项回顾性观察性研究包括连续无症状且至少有中度 AS（平均压力梯度≥ 20 mmHg 或主动脉瓣面积 < 1.5 cm2）且左心室射血分数保留（≥50%）且接受 ESE 的患者。其中，排除了 10 名无症状转诊进行主动脉瓣置换术的患者。最后 99 名接受保守治疗的患者（73 ± 13 岁；54% 为男性）参加了这项研究。所有患者均接受 AS 相关事件随访。结果 在平均 14 ± 11 个月的随访期间，23 名患者经历了 AS 相关事件。尽管在运动期间的平均压力梯度方面没有发现不良事件的患者之间存在差异，但在经历不良事件的患者中，运动期间的跨瓣流速 (Ex-FR) 较低（236 ± 55 vs 274 ± 64毫升/秒，P = .01）。多变量 Cox 回归分析显示，与无症状 AS 患者的不良事件独立相关的 Ex-FR (<270 mL/sec) 降低（风险比 = 3.53，P < .01）。结论 本研究的结果表明，ESE 测量的 Ex-FR 可以在无症状 AS 患者的风险分层中发挥关键作用。23 名患者接受了 AS 相关事件。尽管在运动期间的平均压力梯度方面没有发现不良事件的患者之间存在差异，但在经历不良事件的患者中，运动期间的跨瓣流速 (Ex-FR) 较低（236 ± 55 vs 274 ± 64毫升/秒，P = .01）。多变量 Cox 回归分析显示，与无症状 AS 患者的不良事件独立相关的 Ex-FR (<270 mL/sec) 降低（风险比 = 3.53，P < .01）。结论 本研究的结果表明，ESE 测量的 Ex-FR 可以在无症状 AS 患者的风险分层中发挥关键作用。23 名患者接受了 AS 相关事件。尽管在运动期间的平均压力梯度方面没有发现不良事件的患者之间存在差异，但在经历不良事件的患者中，运动期间的跨瓣流速 (Ex-FR) 较低（236 ± 55 vs 274 ± 64毫升/秒，P = .01）。多变量 Cox 回归分析显示，与无症状 AS 患者的不良事件独立相关的 Ex-FR (<270 mL/sec) 降低（风险比 = 3.53，P < .01）。结论 本研究的结果表明，ESE 测量的 Ex-FR 可以在无症状 AS 患者的风险分层中发挥关键作用。发生不良事件的患者在运动期间的跨瓣流速 (Ex-FR) 较低（236 ± 55 对 274 ± 64 mL/sec，P = .01）。多变量 Cox 回归分析显示，与无症状 AS 患者的不良事件独立相关的 Ex-FR (<270 mL/sec) 降低（风险比 = 3.53，P < .01）。结论 本研究的结果表明，ESE 测量的 Ex-FR 可以在无症状 AS 患者的风险分层中发挥关键作用。发生不良事件的患者在运动期间的跨瓣流速 (Ex-FR) 较低（236 ± 55 对 274 ± 64 mL/sec，P = .01）。多变量 Cox 回归分析显示，与无症状 AS 患者的不良事件独立相关的 Ex-FR (<270 mL/sec) 降低（风险比 = 3.53，P < .01）。结论 本研究的结果表明，ESE 测量的 Ex-FR 可以在无症状 AS 患者的风险分层中发挥关键作用。