TREADMILL stress testing in patients with asymptomatic severe aortic stenosis identified symptoms and indications for aortic valve replacement in approximately 15% of cases, according to a prespecified registry based follow up study.
Exercise stress testing is recommended in asymptomatic severe aortic stenosis to uncover symptoms that may influence the timing of intervention. However, its use in routine clinical practice remains limited.
Investigators evaluated outcomes among patients who underwent a standardised treadmill stress test during screening for a large clinical trial assessing treatment strategies in severe aortic stenosis.
The registry included apparently asymptomatic patients with severe aortic stenosis who were assessed across 75 clinical sites in the United States between July 2017 and December 2021.
Among 1,250 screened individuals, 962 met trial eligibility criteria. Of these, 816 patients had a normal treadmill stress test result, while 146 had a positive result.
A total of 105 patients with positive findings enrolled in the registry and were followed for up to two years.
The mean age of participants was 76.1 years, and 76.2% were male. The treadmill stress test was reported to be safe, with no deaths, syncope, or cardioversion events occurring during testing.
Multivariable analysis identified several baseline predictors of a positive treadmill stress test.
These included higher peak aortic valve velocity, lower ejection fraction, previous coronary artery bypass surgery, and prior stroke.
The findings suggest that certain patient characteristics may help clinicians identify individuals more likely to demonstrate previously unrecognised symptoms or physiological abnormalities during exercise assessment.
Clinical outcomes remained favourable during follow up. The two-year Kaplan-Meier all-cause mortality rate was 5.7%.
Among patients with a positive treadmill stress test result, rates of aortic valve replacement reached 79.9% at one year and 85.9% at two years.
Investigators also found that mortality and aortic valve replacement rates were similar among patients with a Class I indication for intervention, defined by symptoms during testing, and those with a Class IIa indication based on a drop in systolic blood pressure.
Despite the identification of treatment indications, around one fifth of patients with a positive treadmill stress test remained untreated after one year.
The findings highlight the potential value of treadmill stress testing for uncovering clinically relevant symptoms and supporting timely referral for aortic valve replacement in patients with asymptomatic severe aortic stenosis.
Reference
Généreux P et al. Treadmill Stress Test in Patients with Asymptomatic Severe Aortic Stenosis: A Prespecified Registry-Based Follow-Up of the EARLY TAVR Randomized Clinical Trial. JAMA Cardiol. 2026;DOI:10.1001/jamacardio.2026.2527
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