Stress Testing in Patients with Asymptomatic Severe Aortic Stenosis

The natural history of valvular aortic stenosis (AS) is characterized by a protracted symptom free period during which morbidity and mortality are very low. During this period the average decrease in the aortic valve area is about 0.1 cm2 per year (1-4), although it is impossible to predict the rate of progression in an individual patient. For this reason, regular clinical follow-up is standard of care in all patients with asymptomatic mild to moderate AS (1). The onset of symptoms such as: angina, syncope, or heart failure significantly changes prognosis, with an average survival of 60% at 1 year and has increased risk of sudden cardiac death (5-7).