Journal Article

Diastolic Stress Echocardiography Using the Six-Minute Walk Test in Asymptomatic Patients With Aortic Stenosis

Sato, Yukio, Kuwata, Shingo, Izumo, Masaki, Shoji, Tatsuro, Murata, Risako, Oda, Ryutaro, Miyahara, Daisuke, Okuno, Taishi, Akashi, Yoshihiro J., Yamaga, Mitsuki

2025

Overview

Diastolic stress echocardiography is useful in patients with heart failure with preserved ejection fraction (EF); however, its utility in asymptomatic patients with aortic stenosis (AS) remains unexplored. We investigated the value of diastolic stress echocardiography using a 6-minute walk test (6-MWT) in elderly AS patients. This retrospective observational study included 96 consecutive asymptomatic patients (82 years, 39.6% male) with at least moderate AS (mean pressure gradient (MPG) ≥ 20 mm Hg or aortic valve area < 1.5 cm2) and preserved left ventricular EF. All underwent diastolic stress echocardiography using the 6-MWT. Patients were classified into a post-exercise impaired relaxation pattern (pIR) and a post-exercise pseudo-normalised/restrictive pattern (pPN) groups, based on transmitral flow velocity post-6-MWT. The primary endpoint was the time to first occurrence of the composite endpoint (all-cause mortality, aortic valve replacement due to AS-related symptoms, and hospitalization for heart failure).22 patients (23%) changed from baseline IR pattern at rest to the pPN pattern after the 6-MWT.The pPN group demonstrated lower %predicted walking distance than the pIR group. Additionally, the pPN group exhibited greater dyspnea after the 6-MWT. During a median follow-up of 536 days (interquartile range, 106–720 days), 46 patients experienced AS-related events. Multivariable Cox regression analysis indicated that the pPN group was independently associated with increased event risk (hazard ratio: 5.37, p < 0.001). In conclusion, this study suggests that the diastolic stress echocardiography using the 6-MWT is useful for risk stratification in asymptomatic elderly AS patients.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aged / Aged, 80 and over / Aorta / Aortic stenosis / Aortic valve / Aortic Valve Stenosis - diagnosis / Aortic Valve Stenosis - diagnostic imaging / Aortic Valve Stenosis - physiopathology / Asymptomatic / Asymptomatic Diseases / Cardiology / Cardiovascular disease / Congestive heart failure / Diastole / diastolic stress test / Dyspnea / Echocardiography / Echocardiography, Stress - methods / Ejection fraction / Exercise / exercise echocardiography / Female / Flow velocity / Follow-Up Studies / Frailty / Heart failure / Heart valves / Hospitalization / Humans / Male / Mortality / Older people / Physical fitness / Pulse oximetry / Regression analysis / Respiration / Retrospective Studies / Stress / Stroke Volume - physiology / Velocity / Ventricular Function, Left - physiology / Walk Test - methods / Walking