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Exercise Testing in Asymptomatic AS — EECC MCQ

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ModerateValvular Heart DiseaseExercise Testing in Asymptomatic ASEECC

A 60-year-old man with severe AS undergoes exercise stress echocardiography. He develops 4 mm ST depression at low workload with a hypotensive blood pressure response. What does this indicate?

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Correct answer: B — Symptomatic response to exercise testing in asymptomatic severe AS — an abnormal blood pressure response and/or significant ST changes trigger the indication for valve intervention

Exercise testing in asymptomatic severe AS is used to unmask symptoms and assess the haemodynamic response. The 2025 ESC VHD Guidelines consider the following as abnormal responses triggering intervention consideration: (1) symptom development (breathlessness, chest pain, dizziness/presyncope); (2) blood pressure fall or failure to rise >20 mmHg (hypotensive response); (3) significant ST depression (>2 mm); (4) complex ventricular arrhythmias. These findings indicate an inability to augment cardiac output and maintain coronary perfusion during exercise, suggesting the patient is at high risk for adverse events if the AS remains untreated. Exercise testing should be supervised by a cardiologist with resuscitation equipment available and is contraindicated in symptomatic patients.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease