Relationship between exercise pressure gradient and haemodynamic progression of aortic stenosis

Abstract : Background and aims. - We hypothesized that large exercise-induced increases in aortic mean pressure gradient can predict haemodynamic progression during follow-up in asymptomatic patients with aortic stenosis. Methods. - We retrospectively identified patients with asymptomatic moderate or severe aortic stenosis (aortic valve area < 1.5 cm(2) or < 1 cm(2)) and normal ejection fraction, who underwent an exercise stress echocardiography at baseline with a normal exercise test and a resting echocardiography during follow-up. The relationship between exercise-induced increase in aortic mean pressure gradient and annualised changes in resting mean pressure gradient during follow-up was investigated. Results. - Fifty-five patients (mean age 66 15 years; 45% severe aortic stenosis) were included. Aortic mean pressure gradient significantly increased from rest to peak exercise (P < 0.001). During a median follow-up of 1.6 [1.1-3.2] years, resting mean pressure gradient increased from 35 +/- 13 mmHg to 48 16 mmHg, P < 0.0001. Median annualised change in resting mean pressure gradient during follow-up was 5 [2-11] mmHg. Exercise-induced increase in aortic mean pressure gradient did correlate with annualised changes in mean pressure gradient during follow-up (r=0.35, P=0.01). Hemodynamic progression of aortic stenosis was faster in patients with large exercise-induced increase in aortic mean pressure gradient (> 20 mmHg) as compared to those with exercise-induced increase in aortic mean pressure gradient < 20 mmHg (median annualised increase in mean pressure gradient 19 [6-28] vs. 4 [2-10] mmHg/y respectively, P=0.002). Similar results were found in the subgroup of 30 patients with moderate aortic stenosis. Conclusion. - Large exercise-induced increases in aortic mean pressure gradient correlate with haemodynamic progression of stenosis during follow-up in patients with asymptomatic aortic stenosis. Further studies are needed to fully establish the role of ESE in the decision-making process in comparison to other prognostic markers in asymptomatic patients with aortic stenosis. (C) 2017 Elsevier Masson SAS. All rights reserved.