ST-segment/heart rate hysteresis improves the exercise testing accuracy for coronary artery detection in asymptomatic patients with severe aortic stenosis

ObjectiveTo assess the safety and tolerability of treadmill exercise testing and the association of revealed symptoms with outcome in apparently asymptomatic patients with moderate to severe aortic stenosis (AS).MethodsA retrospective cohort study of 316 patients (age 65±12 years, 67% men) with moderate and severe AS who underwent echocardiography and modified Bruce exercise treadmill tests (ETTs) at a specialist valve clinic. The outcome measures were aortic valve replacement (AVR), all-cause mortality or a composite of AVR and all-cause mortality.ResultsAt baseline, there were 210 (66%) patients with moderate and 106 (34%) with severe AS. There were 264 (83%) events. 234 (74%) patients reached an indication for AVR, 145 (69%) with moderate and 88 (83%) with severe AS (p<0.05). Of the 30 (9%) deaths recoded during follow-up, 20 (67%) were cardiovascular related. In total, 797 exercise tests (mean 2.5±2.1 per patient) were performed. No serious adverse events were observed. The prevalence of revealed symptoms at baseline ETT was 29% (n=91) and was significantly higher in severe AS compared with moderate AS (38%vs23%, p=0.008). Symptoms were revealed in 18%–59% of patients during serial ETT conducted over a follow-up period of 34.9 (SD 35.1) months. The event-free survival at 24 months with revealed symptoms was 46%±4% and without revealed symptoms was 70%±4%.ConclusionsETT in patients with moderate or severe AS is safe and tolerable. Serial exercise testing is useful to reveal symptoms not volunteered on the history and adds incremental prognostic information to baseline testing.

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Comparison of the diagnostic accuracy of different methods of measurement of heart rate-adjusted ST-segment depression during exercise testing for identification of coronary artery disease

The American Journal of Cardiology ◽

10.1016/s0002-9149(99)80325-7 ◽

1995 ◽

Vol 76 (16) ◽

pp. 1147-1151 ◽

Cited By ~ 9

Author(s):

Daniel Herpin ◽

Jérôme Ferrandis ◽

Patrick Borderon ◽

Bernard Gaudeau ◽

Stéphanie Ragot ◽

...

Keyword(s):

Coronary Artery Disease ◽

Heart Rate ◽

Coronary Artery ◽

Diagnostic Accuracy ◽

Exercise Testing ◽

St Segment ◽

Artery Disease ◽

Methods Of Measurement

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Rapid early rise in heart rate on treadmill exercise in patients with asymptomatic moderate or severe aortic stenosis: a new prognostic marker?

Open Heart ◽

10.1136/openhrt-2018-000950 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000950 ◽

Cited By ~ 4

Author(s):

John B Chambers ◽

Ronak Rajani ◽

Denise Parkin ◽

Sahrai Saeed

Keyword(s):

Heart Rate ◽

Aortic Stenosis ◽

Predictive Value ◽

Cox Regression ◽

Blood Pressure Response ◽

Severe Aortic Stenosis ◽

Regression Analyses ◽

Asymptomatic Patients ◽

All Cause Mortality ◽

Early Rise

ObjectiveTo examine the clinical significance and prognostic value of an early rapid rise in heart rate (RR-HR) in asymptomatic patients with moderate or severe aortic stenosis (AS).MethodsWe retrospectively assessed the prospectively collected data from 306 patients (age 65±12 years, 33% women) with moderate (n=204) or severe AS (n=102) with a median follow-up of 25 months (mean 34.9±34.6 months). All had echocardiography and modified Bruce exercise treadmill tests (ETT). RR-HR was defined as achieving 85% target HR or ≥50% increase from baseline in the first 6 min. The outcome measures were revealed symptoms during ETT, aortic valve replacement (AVR) and all-cause mortality.ResultsRR-HR occurred in 77 (25%) and 64% developed revealed symptoms (postive predictive value 64% and negative predictive value 84%). On univariate Cox regression analyses in patients with severe AS, RR-HR was associated with AVR (HR 3.32, 95% CI 2.03 to 5.45, p<0.001) but not with all-cause mortality (HR 0.04, 95% CI 0.13 to 9.21, p=0.798). In patients with moderate AS, RR-HR was associated with all-cause mortality (HR 2.67, 95% CI 1.09 to 6.56, p=0.032), but not with AVR (HR 1.35, 95% CI 0.92 to 1.98, p=0.127). These associations remained significant in multivariate Cox regression analyses after adjustment for age, sex, hypertension, coronary artery disease, abnormal blood pressure response, Doppler stroke volume and mean pressure gradient (both p<0.001).ConclusionsRR-HR was associated with the development of revealed symptoms. It predicted revealed symptoms on serial ETT, AVR in severe AS and all-cause mortality in moderate AS. RR-HR may be a useful new measure to define risk in AS.

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