Utility of Stress Testing in Valvular Aortic Stenosis

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In selected patients with valvular aortic stenosis, stress testing can provide usecul information that complements the date obtained by history, physical examination, and echocardiography. This paper reviews the exercise physiology in patients with valvular aortic stenosis compared with normats, in addition, the utility of strees testing in aortic stenosis is discussed, including evaluation of symptom status and functional capacity, assistance with an exercise prescription, diagnosis of coexisting coronary artery disease, and determination of the etiology of associated left ventricutar systotic dysfunction. We recommend assessment of stenosis severity by Doppler echocardiography in all subjects before stress testing. In situations in which stress testing is expected to provide incremental data, the clinician should a) carefully consider the value of the diagnostic information to be obtained and b) review the patient's current symptom status in datail. It severe symptoms caused by valvular obstruction are present, stress testing should not be performed. With absent or less severe symptoms, or with an equivocal clinical presentation, stress testing can be performed cautiousiy. In the future, exercise and stress testing may assume a greater role in clinical decision making in aortic stenosis patients

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