Abstract 16525: Exercise Stress Echocardiography in Patients with Aortic Stenosis: Impact of Baseline Diastolic Dysfunction and Functional Capacity on Mortality and Aortic Valve Replacement

Abstract

Background Asymptomatic patients with various degrees of aortic stenosis (AS) often undergo exercise echocardiography. Decreased functional capacity (FC) and diastolic dysfunction (DD) have been associated with AS; however, little is known about their impact on mortality or need for aortic valve replacement (AVR).

Objectives To determine the relationship between DD and FC on all-cause mortality and need for AVR in patients with AS presenting for an exercise echocardiogram.

Methods We analyzed data for consecutive patients with any degree of AS who were referred for exercise echocardiography at our institution between 2000 to 2010. Data on DD and maximum metabolic equivalents (METs) was extracted from reports. The primary endpoint was a composite of death or need for AVR.

Results We identified 1267 patients with a mean age of 67 +/- 11 years, ejection fraction of 56 +/-7%, mean aortic valve gradient of 19 +/- 12 mmHg, and mean maximal METs achieved of 8 +/- 2.6. The proportion of patients with normal, stage 1, and ≥ stage 2 diastology was 195 (15%), 928 (73%), 144 (12%) respectively. There were 164 (12.9%) deaths at a mean follow up of 5.6 +/- 4.1 years (no deaths occurred within 30 days of stress testing) and 341 (27%) patients required AVR at a mean follow up of 2.4 +/- 2.6 years. Independent predictors of FC were age, gender, body mass index, Bruce protocol, heart rate recovery, ejection fraction, mean aortic valve gradient, and diabetes but not baseline DD. On adjusted multivariate analysis, baseline DD (HR 1.82, CI 1.17-2.82, p=0.008) and FC (HR 0.93, CI 0.88-0.98, p=0.003) were independent predictors of the combined endpoint.

Conclusions In patients with AS undergoing exercise echocardiography, baseline DD was not predictive of FC. However, both baseline DD and FC were independent predictors of the combined endpoint of death or need for AVR.