Systolic blood pressure response during exercise testing in symptomatic severe aortic stenosis

Area of Science:

• Cardiology
• Cardiopulmonary Exercise Testing
• Aortic Stenosis Management

Background:

• Exercise testing is underutilized in aortic stenosis (AS) due to concerns about exercise-induced systolic blood pressure (SBP) drops.
• This study investigates the SBP response to exercise in severe symptomatic AS patients before and after aortic valve replacement.

Purpose of the Study:

• To assess the safety and feasibility of maximal cardiopulmonary exercise testing (CPET) in patients with severe symptomatic AS.
• To analyze the SBP response during CPET before and 1 year after aortic valve replacement surgery.

Main Methods:

• Prospective observational cohort study of 45 patients undergoing aortic valve replacement for severe symptomatic AS.
• Maximal CPET performed preoperatively and 1 year postoperatively using a cycle ergometer.
• SBP response categorized as 'normal', 'flat', or 'drop' based on SBP/watt-slope.

Main Results:

• No adverse events reported during CPET.
• Preoperatively, 4/45 patients showed an SBP drop, 23 had a 'flat' response, and 18 had a 'normal' response.
• Postoperatively, maximal SBP and SBP/watt-slope significantly increased (p<0.001), with 74% showing a 'normal' SBP response compared to 43% preoperatively (p=0.0046).

Conclusions:

• Exercise-induced SBP drop is infrequent (<10%) in severe symptomatic AS patients.
• CPET can be safely performed in AS patients under careful monitoring.
• Aortic valve replacement improves the SBP response to exercise, with no patients experiencing an SBP drop postoperatively.