Clinical value of stress echocardiography in moderate aortic stenosis
Research type
Research Study
Full title
Clinical value of stress echocardiography in moderate aortic stenosis
IRAS ID
202354
Contact name
Anastasia Vamvakidou
Contact email
Sponsor organisation
London North West Healthcare NHS Trust
Clinicaltrials.gov Identifier
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
The prevalence of aortic valve stenosis (AS) has increased over the last few decades due to improvement in life expectancy and a growing elderly population. A wealth of data is available on patients with severe AS, whereas the risk stratification and management of patients with symptomatic moderate AS remains contentious. Despite the uncertainty, the mortality of symptomatic moderate AS approaches the one of severe AS. \nStress echocardiography (exercise or pharmacological) is a recognised tool for the risk stratification of patients with suspected severe stenosis. Specific indices, mainly the increase in pressure gradients across the aortic valve, have prognostic implications in severe AS. The technique could be applied in patients with moderate AS who have relevant symptoms (i.e. breathlessness, chest pain or syncope). Furthermore other modalities like CT calcium score, speckle tracking echocardiography, carotid ultrasonography, and NT-proBNP that have also been shown to aid in the prognostication of severe AS could in combination with SE guide the management of this patient group.\nPatients with symptomatic moderate AS will initially have a six-minute walk test to objectively assess their symptoms. Following this they will have a stress echo (exercise or pharmacological if cannot exercise) where transvalvular gradients at rest and at stress will be compared (an increase >20mmHg will be used as cut-off). Additional assessments will include quantitative myocardial perfusion analysis, deformation analysis (off line), NT-proBNP blood test and carotid ultrasound. The patient will then attend for a CT scan for assessment of calcification of the aortic valve. \nFollow-up will be performed one year after with standard transthoracic echocardiography for assessment of change in AS severity/LV systolic function, and two years after via review of hospital records and/or telephone consultation for assessment of clinical outcomes. The clinical outcomes assessed will include death (all-cause/ cardiovascular), hospitalisation with heart failure and aortic valve intervention. \n
REC name
London - Bromley Research Ethics Committee
REC reference
16/LO/1127
Date of REC Opinion
21 Jun 2016
REC opinion
Favourable Opinion