Aortic stenosis cardiac stress test

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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.

AHA/ACC 2014 Guideline for the Management of Patients With Valvular Heart Diseases

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)"

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

Cardiac Stress Test (DO NOT EDIT)

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)"

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)

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)"