186 Specificity of Left Ventricular Response to Exercise in Patients with Asymptomatic Valvular Aortic Stenosis

Abstract

To determine whether left ventricular systolic and/or diastolic functions during an exercise stress echocardiography can identify early left ventricular (LV) dysfunction in asymptomatic patients with severe aortic stenosis (AoS). A bicentric case–control study was performed about 207 patients with AoS, without symptoms, a peak aortic valve velocity 3 m/s, and LV ejection fraction (EF) >50% and 43 aged-matched normal controls. An echocardiogram was performed at rest and during a standardized exercise stress test. Tissue Doppler, 2D-strain as well as conventional echocardiography was identically performed for every patients at rest and during an exercise at 120±10 beats/min. For patients with AoS, mean (SD) aortic valve area was 0.87 (0.19) cm 2 . At rest, LVEF was similar for patients with AoS and controls, respectively (65.6 (9.1) vs 63.3 (6.6) %, p = 0.1). However, S’ (tissue Doppler systolic peak) (6.2 (2.3) vs 7.7 (1.2) cm/s, p<0.001) and the increase in S’ during exercise (7.5 (2.6) vs 11.6 (1.3) cm/s, p<0.001) were lower in patients with AoS. The difference was even greater considering global longitudinal systolic strain (GLS) at rest (-15.4 (4.0) vs -20.2 (2.7)) and during exercise (-16.5 (4.9) vs -24.6 (3.5)). The best discriminant parameter between the 2-populations was the exercise GLS with a cut-off of -21.9 providing 83.7% specificity and 89.8% sensitivity. In patients with similar LV EF, LV longitudinal deformation measured by 2D-S is providing at rest and even more exercising a clinically relevant tool to distinguish subclinical LV dysfunction induced by the chonic overload due to severe AoS.