Cardiopulmonary exercise testing is a better outcome predictor than exercise echocardiography in asymptomatic aortic stenosis

Abstract Background Objective assessment of maximal aerobic capacity using peak oxygen consumption (peak VO2) can be helpful in the management of patients with asymptomaticaortic stenosis (AS). The relationship between peak VO2 and AS severity criteria derived from rest and supine exercise echocardiography (SEE) has never been explored. Objectives We aimed to determine whether low peak VO2 ( Methods Fifty one asymptomaticpatients (mean age of 54±21years) with moderate to severe aortic stenosis (Vmax>3m/s) and left ventricle ejection fraction>50% prospectively underwent resting and SEE and cardiopulmonary exercise testing(CPX). Results Peak VO2 was lower than expected (21.9±7.4mL/kg/min), i.e. Conclusion CPX detects a high proportion of false asymptomaticAS patients with poorer outcome that cannot be predicted by SEE markers of AS severity. Assessment of aerobic capacity should be part of current approach within a " watchful waiting" strategy.