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Exercise echocardiography in asymptomatic patients with severe aortic stenosis and preserved left ventricular ejection fraction.

Henri C, Lancellotti P - J Cardiovasc Ultrasound (2014)

Bottom Line: Recent series reported that early aortic valve replacement might be associated with improved clinical outcomes.However, the risk-benefit ratio should be carefully evaluated and early surgery only be proposed to a subset of asymptomatic patients considered at higher risk.The purpose of this article is to describe the role of exercise testing and echocardiography in the management of asymptomatic patients with severe AS and preserved left ventricular ejection fraction.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Heart Valve Clinic, GIGA Cardiovascular Sciences, University of Liège, CHU Sart Tilman, Liège, Belgium.

ABSTRACT
The management of asymptomatic patients with severe aortic stenosis (AS) remains controversial. Recent series reported that early aortic valve replacement might be associated with improved clinical outcomes. However, the risk-benefit ratio should be carefully evaluated and early surgery only be proposed to a subset of asymptomatic patients considered at higher risk. Exercise echocardiography can help unmask symptomatic patients combined with assessment of the hemodynamic consequences of AS. Recent studies have demonstrated that exercise echocardiography can provide incremental prognostic value to identify patients who may benefit most from early surgery. In "truly" asymptomatic patients, an increase in mean aortic gradient ≥ 18-20 mmHg, a limited left ventricular contractile reserve or a pulmonary hypertension during exercise are predictive parameters of adverse cardiac events. Exercise echocardiography is low-cost, safe and available in many referral centers, and does not expose patients to radiation. The purpose of this article is to describe the role of exercise testing and echocardiography in the management of asymptomatic patients with severe AS and preserved left ventricular ejection fraction.

No MeSH data available.


Related in: MedlinePlus

Exercise echocardiography protocol including the sequence of acquisition. *Should be measured at low-level exercise before E and A wave fusion. CW: continuous-wave Doppler, fps: frame per second, LV: left ventricle, PW: pulsed-wave Doppler, SPAP: systolic pulmonary artery pressure, TDI: tissue Doppler imaging, TR: tricuspid regurgitation.
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Figure 2: Exercise echocardiography protocol including the sequence of acquisition. *Should be measured at low-level exercise before E and A wave fusion. CW: continuous-wave Doppler, fps: frame per second, LV: left ventricle, PW: pulsed-wave Doppler, SPAP: systolic pulmonary artery pressure, TDI: tissue Doppler imaging, TR: tricuspid regurgitation.

Mentions: In valvular heart disease, an experienced sonographer or cardiologist should perform exercise echocardiography. Both types of exercise test can be used. Treadmill allows only post-exercise imaging limiting the accuracy of measurements compared to semi-supine cyclo-ergometer permitting optimal image acquisitions during each step of exercise testing. Comprehensive resting echocardiography should be performed in the same position as during the exercise testing. Echocardiographic parameters related to the severity of AS, the consequences on the LV and the systolic pulmonary arterial pressure (SPAP) should be recorded throughout the test. To note, the ratio of early diastolic mitral inflow velocity to early diastolic annulus velocity (E/e' ratio) should be measured before E and A wave fusion appearing at higher heart rates (usually > 100-110 bpm) (Fig. 2).


Exercise echocardiography in asymptomatic patients with severe aortic stenosis and preserved left ventricular ejection fraction.

Henri C, Lancellotti P - J Cardiovasc Ultrasound (2014)

Exercise echocardiography protocol including the sequence of acquisition. *Should be measured at low-level exercise before E and A wave fusion. CW: continuous-wave Doppler, fps: frame per second, LV: left ventricle, PW: pulsed-wave Doppler, SPAP: systolic pulmonary artery pressure, TDI: tissue Doppler imaging, TR: tricuspid regurgitation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3992342&req=5

Figure 2: Exercise echocardiography protocol including the sequence of acquisition. *Should be measured at low-level exercise before E and A wave fusion. CW: continuous-wave Doppler, fps: frame per second, LV: left ventricle, PW: pulsed-wave Doppler, SPAP: systolic pulmonary artery pressure, TDI: tissue Doppler imaging, TR: tricuspid regurgitation.
Mentions: In valvular heart disease, an experienced sonographer or cardiologist should perform exercise echocardiography. Both types of exercise test can be used. Treadmill allows only post-exercise imaging limiting the accuracy of measurements compared to semi-supine cyclo-ergometer permitting optimal image acquisitions during each step of exercise testing. Comprehensive resting echocardiography should be performed in the same position as during the exercise testing. Echocardiographic parameters related to the severity of AS, the consequences on the LV and the systolic pulmonary arterial pressure (SPAP) should be recorded throughout the test. To note, the ratio of early diastolic mitral inflow velocity to early diastolic annulus velocity (E/e' ratio) should be measured before E and A wave fusion appearing at higher heart rates (usually > 100-110 bpm) (Fig. 2).

Bottom Line: Recent series reported that early aortic valve replacement might be associated with improved clinical outcomes.However, the risk-benefit ratio should be carefully evaluated and early surgery only be proposed to a subset of asymptomatic patients considered at higher risk.The purpose of this article is to describe the role of exercise testing and echocardiography in the management of asymptomatic patients with severe AS and preserved left ventricular ejection fraction.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Heart Valve Clinic, GIGA Cardiovascular Sciences, University of Liège, CHU Sart Tilman, Liège, Belgium.

ABSTRACT
The management of asymptomatic patients with severe aortic stenosis (AS) remains controversial. Recent series reported that early aortic valve replacement might be associated with improved clinical outcomes. However, the risk-benefit ratio should be carefully evaluated and early surgery only be proposed to a subset of asymptomatic patients considered at higher risk. Exercise echocardiography can help unmask symptomatic patients combined with assessment of the hemodynamic consequences of AS. Recent studies have demonstrated that exercise echocardiography can provide incremental prognostic value to identify patients who may benefit most from early surgery. In "truly" asymptomatic patients, an increase in mean aortic gradient ≥ 18-20 mmHg, a limited left ventricular contractile reserve or a pulmonary hypertension during exercise are predictive parameters of adverse cardiac events. Exercise echocardiography is low-cost, safe and available in many referral centers, and does not expose patients to radiation. The purpose of this article is to describe the role of exercise testing and echocardiography in the management of asymptomatic patients with severe AS and preserved left ventricular ejection fraction.

No MeSH data available.


Related in: MedlinePlus