NEW YORK (Reuters Health) – Stress testing can be safely done in asymptomatic patients with severe aortic stenosis and is useful in predicting adverse cardiac events, including sudden cardiac death, according to a report in the American Journal of Cardiology for October 1.

The management of such patients is controversial, Dr. Robert J. Siegel, from Cedars-Sinai Heart Institute, Los Angeles, and colleagues note. “Aortic valve replacement has significant morbidity and mortality, while there is a risk for sudden cardiac death with conservative management.”

To evaluate the prognostic value of stress testing, the researchers conducted a meta-analysis of data from seven studies identified through a search of Ovid/Medline. A total of 491 patients with asymptomatic severe aortic stenosis were included in the analysis.

No complications occurred in any of the patients before or after stress testing, the researchers note.

After one year of follow-up, 21% of patients with a normal stress test result experienced an adverse cardiac event compared with 66% of those with an abnormal result (OR = 0.12, p < 0.001). A normal stress test result essentially ruled out sudden cardiac death within the next year. By contrast, 5% of patients with an abnormal result had sudden cardiac death within the year. “These data suggest that stress tests can be used for risk stratification and for deciding on the timing of aortic valve replacement in asymptomatic patients with severe aortic stenosis,” the authors conclude. Reference:
Am J Cardiol 2009;104:972-977.