Value of Exercise Testing to Evaluate the Indication for Surgery in Asymptomatic Patients with Valvular Aortic Stenosis
Domenico Alborino MD, Jacques Lars Hoffmann MD, Pierre Claude Fournet MD, Antoine Bloch MD

This study assessed the value of exercise stress testing to identify asymptomatic patients with moderate or severe valvular aortic stenosis (AS). These patients often develop symptoms during follow up, and require valve replacement surgery (VRS) at one to three years after single symptom-limited exercise stress testing. Limited data are available on predictors of outcome in asymptomatic patients with valvular AS. The safety and diagnostic accuracy of exercise testing to predict symptom development and need for VRS was assessed in 30 asymptomatic patients (mean age 62 ± 14 years) with valvular AS. There were no complications during and after exercise testing. All patients were followed up for at least 36 months. Ergometry was abnormal in 18 patients (60%). During the following 12 months all patients with a normal exercise test remained asymptomatic. Ten patients with abnormal exercise test experienced symptoms and required VRS. After 36 months, two patients with a normal exercise test developed symptoms and required VRS. Among subjects with abnormal exercise test, four required surgery. At three years after exercise testing, 10 patients with a normal exercise stress test and four with an abnormal test did not require VRS as they were still asymptomatic. There was no significant difference in valvular aortic area and maximal and mean gradient between patients with normal and abnormal exercise tests. In conclusion, exercise stress testing may be performed safely in asymptomatic patients with moderate or severe valvular AS. Tests which meet criteria for normal patients allow physicians confidently to postpone valvular surgery and to suggest a simple, cost-effective method of follow up in such cases. An abnormal test may reveal symptoms or identify a population for closer follow up.