Cardiopulmonary exercise testing is a better outcome predictor than exercise echocardiography in asymptomatic aortic stenosis

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• 作者：Olivia Domanski^a ; ¹ ; ^{Olivia.domanski@chru-lille.fr} ; Marjorie Richardson^a ; ¹ ; Augustin Coisne^a ; ^b ; ^c ; ^d ; ^e ; Anne-Sophie Polge^a ; Stephanie Mouton^a ; Franç ; ois Godart^a ; ^b ; Jean Louis Edmé ; ^a ; ^b ; Regis Matran^a ; ^b ; ^d ; Patrizio Lancellotti^f ; ^g ; David Montaigne^a ; ^b ; ^c ; ^d ; ^e ;
• 关键词：AS ; Aortic stenosis ; BMI ; Body Mass Index ; CPX ; Cardiopulmonary exercise testing ; EPHT ; Exercise pulmonary hypertension ; LVEF ; Left ventricle ejection fraction ; MGI ; Mean gradient increase ; PHT ; Pulmonary hypertension ; TAPSE ; Tricuspid annular plane systolic excursion ; VO2 ; Oxygen consumption
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：15 January 2017
• 年：2017
• 卷：227
• 期：Complete
• 页码：908-914
• 全文大小：434 K
• 卷排序：227

文摘

Objective assessment of maximal aerobic capacity using peak oxygen consumption (peak VO2) can be helpful in the management of patients with asymptomatic aortic stenosis (AS). The relationship between peak VO2 and AS severity criteria derived from rest and supine exercise echocardiography (SEE) has never been explored.ObjectivesWe aimed to determine whether low peak VO2 (< 85% of predicted value) is associated with severity parameters in SEE, and poor clinical outcome.MethodsFifty one asymptomatic patients (mean age of 54 ± 21 years) with moderate to severe aortic stenosis (Vmax > 3 m/s) and left ventricle ejection fraction > 50% prospectively underwent resting and SEE and cardiopulmonary exercise testing (CPX).ResultsPeak VO2 was lower than expected (21.9 ± 7.4 mL/kg/min), i.e. < 85% of predicted value in 57% patients, secondary to cardiac limitation in most of them (69%). In multiple regression analysis, age, BMI and female gender were the only independent determinants of peak VO2. Interestingly no parameter derived from SEE was associated with peak VO2. After 21 ± 7 month follow-up, no patient died, 20 underwent cardiac surgery. Peak VO2 < 85% of predicted value was associated with lower event free survival compared to normal peak VO2 (57% ± 11% vs 93 ± 6%, p = 0.036) whereas no exercise echocardiographic parameter could predict such events. Peak VO2 ≥ 85% had a negative predictive value of 97%.ConclusionCPX detects a high proportion of false asymptomatic AS patients with poorer outcome that cannot be predicted by SEE markers of AS severity. Assessment of aerobic capacity should be part of current approach within a “watchful waiting” strategy.