We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Exercise stress echocardiography with tissue Doppler imaging in risk stratification of mild to moderate aortic stenosis.
- Authors
Sonaglioni, Andrea; Lombardo, Michele; Baravelli, Massimo; Trotta, Graziana; Sommese, Carmen; Anzà, Claudio; Anzà, Claudio
- Abstract
<bold>Background: </bold>Patients with mild to moderate aortic stenosis (AS) seem to have a worse outcome than commonly expected. Early identification of subjects who may develop a rapid disease progression or cardiovascular events is critical in order to apply adequate risk management.<bold>Study Design: </bold>Observational prospective single-centre study.<bold>Objective: </bold>To determine the prognostic role of exercise stress echocardiography (ESE) in patients with mild and moderate asymptomatic AS.<bold>Patients: </bold>Ninety consecutive patients (mean age 74 ± 12 years) with isolated mild and moderate AS were enrolled into the study protocol over a 20 months period. Follow-up time was 12 months.<bold>Methods: </bold>A complete echocardiographic study with tissue Doppler imaging (TDI) was performed at baseline and during semi-supine symptom-limited exercise test to evaluate: (1) the occurrence of symptoms, (2) ST segment changes, (3) transaortic pressure gradient, (4) the E/A ratio, (5) the E/e' ratio and (6) the systolic pulmonary artery pressure.<bold>Main Outcome Measures: </bold>During the 1 year follow-up time, we evaluated the occurrence of adverse cardiac events, defined as any of the following: (1) cardio-vascular hospitalization; (2) requirement for aortic valve replacement; (3) cardiac death.<bold>Results: </bold>During follow-up, three patients died, 11 underwent aortic valve replacement and 26 had cardiovascular hospitalizations. On univariate analysis, patients who exhibited symptoms during exercise (HR 2.93, p = 0.003); the occurrence of a ≥ 2 mm exercise-induced ST segment depression (HR 3.12, p = 0.001); a ≥ 15 mmHg increase in mean transaortic pressure gradient during exercise (HR 2.77, p = 0.001); a ≥ 50 mmHg exercise-induced increase in systolic pulmonary artery pressure (HR 2.90, p = 0.009); an exercise-induced pseudo-normalization of the E/A ratio (E/A ≥ 1) (HR 7.50, p = 0.0001) and, particularly, a ≥ 15 exercise-induced increase in the E/e' ratio (HR 7.69, p = 0.0001) had a significantly higher risk of cardiac events during the follow-up time. On multivariate analysis, only the latter covariate (HR 6.04, p = 0.009) was independently associated with adverse cardiac events.<bold>Conclusions: </bold>A ≥ 15 stress-induced increase in E/e' ratio is highly predictive of cardiac events in patients with mild to moderate AS. Assessment of diastolic function using TDI during ESE provides additional prognostic information in such patients.
- Subjects
ITALY; DOPPLER echocardiography; AORTIC stenosis; DISEASE progression; HEALTH outcome assessment; LONGITUDINAL method; SCIENTIFIC observation; PROGNOSIS; PATIENTS; AORTIC valve surgery; AORTIC valve; ECHOCARDIOGRAPHY; EXERCISE tests; PROSTHETIC heart valves; HEMODYNAMICS; HOSPITAL care; MULTIVARIATE analysis; TIME; TREATMENT effectiveness; PREDICTIVE tests; PROPORTIONAL hazards models; SEVERITY of illness index; KAPLAN-Meier estimator
- Publication
International Journal of Cardiovascular Imaging, 2015, Vol 31, Issue 8, p1519
- ISSN
1569-5794
- Publication type
journal article
- DOI
10.1007/s10554-015-0724-9