Aortic stenosis cardiac stress test

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Aslam, M.B.B.S[2]; Usama Talib, BSc, MD [3]

Overview

Exercise testing should not be performed in symptomatic patients with AS but can be used to elicit exercise-induced symptoms and abnormal blood pressure responses in asymptomatic patients.[1]

Cardiac stress test

Cardiac stress testing may be used in patients with asymptomatic severe aortic stenosis for risk stratification. An early exercise test such as treadmill may be used. Patients developing symptoms and inadequate blood pressure change <20 mmHg may indicate severe aortic stenosis indicating surgery in such patients. Low dose dobutamine echocardiography may also be used in patients with decreased contractile reserves to stratify the patients as high risk and hence to determine the need for surgery. [2][3]

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Diseases (DO NOT EDIT)[4]

Diagnosis and Follow-Up

Class IIa

"1. Low-dose dobutamine stress testing using echocardiographic or invasive hemodynamic measurements is reasonable in patients with stage D2 AS with all of the following:
a. Calcified aortic valve with reduced systolic opening;
b. LVEF less than 50%;
c. Calculated valve area 1.0 cm2 or less; and
d. Aortic velocity less than 4.0 m per second or mean pressure gradient less than 40 mm Hg. (Level of Evidence: B)"

"2. Exercise testing is reasonable to assess physiological changes with exercise and to confirm the absence of symptoms in asymptomatic patients with a calcified aortic valve and an aortic velocity 4.0 m per second or greater or mean pressure gradient 40 mm Hg or higher. (Level of Evidence: C)"
Class III: Harm
"1. Exercise testing should not be performed in symptomatic patients with AS when the aortic velocity is 4.0 m per second or greater or mean pressure gradient is 40 mm Hg or higher (stage D). (Level of Evidence: B)"

2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) [1]

Cardiac Stress Test (DO NOT EDIT) [1]

Class III
"1. Exercise testing should not be performed in symptomatic patients with AS. (Level of Evidence: B)"
Class IIb

"1. Exercise testing in asymptomatic patients with AS may be considered to elicit exercise-induced symptoms and abnormal blood pressure responses. (Level of Evidence: B)"

Asymptomatic Adolescents (DO NOT EDIT) [1]

Class IIa
"1. Graded exercise testing is a reasonable diagnostic evaluation in the adolescent or young adult with AS who has a Doppler mean gradient greater than 30 mm Hg or a peak velocity greater than 3.5 m per second (peak gradient greater than 50 mm Hg) if the patient is interested in athletic participation, or if the clinical findings and Doppler findings are disparate. (Level of Evidence: C)"

References

  1. 1.0 1.1 1.2 1.3 Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter |month= ignored (help)
  2. Katayama M, Chaliki HP (2016). "Diagnosis and management of patients with asymptomatic severe aortic stenosis". World J Cardiol. 8 (2): 192–200. doi:10.4330/wjc.v8.i2.192. PMC 4766269. PMID 26981214.
  3. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 63 (22): e57–185. doi:10.1016/j.jacc.2014.02.536. PMID 24603191.
  4. "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Retrieved 4 March 2014.


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