Valvular & structural heart disease

Clinical outcomes and haemodynamic response after blinded stress assessment of moderate aortic stenosis

EuroInterventionPublished pilot study

Authors' conclusion

Stress haemodynamic assessment in moderate AS unmasks a subgroup, not identified by conventional metrics, who are at significantly higher risk for AV intervention. Patients with abnormal stress physiology despite only moderate AS at rest may benefit from AV intervention, supporting this pilot study as the basis for a future randomised trial.

Study context

Population
Symptomatic patients with moderate aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF) without an alternative explanation for symptomspatients prospectively enrolled
Participants
52 patients
Comparison
Stress aortic valve index (SAVI) against echocardiographic parameters of AS severity and clinical outcomes
Outcome
Invasive transvalvular gradient
Follow-up
At rest and during dobutamine
Methodological detailsprospectively enrolled, SAVI measured but blinded, followed for ≥1 year
  • Prospectively enrolled
  • SAVI measured but blinded
  • Followed for ≥1 year

Main finding

As reported in the abstract

At rest

25±9 mmHg

During dobutamine

42±14 mmHg

Further findings

OutcomeHazard ratioP value
Need for clinical aortic valve (AV) intervention5.7P = 0.007
  • Need for clinical aortic valve (AV) intervention: independent predictor; Aortic valve area (AVA) and sex-specific calcium thresholds did not predict

Aortic-to-left ventricular pressure ratio · at rest and under stress

At rest
0.82 (interquartile range [IQR] 0.78-0.88)
SAVI under stress
0.70 (IQR 0.63-0.79)

Resting aortic valve area (AVA) and stress haemodynamics

Resting AVA did not predict stress haemodynamics

Patients with SAVI ≤0.70

Patients with SAVI ≤0.70
25/52 (48%)
  • Comparable with a severe AS cohort studied separately

Original publication

Clinical outcomes and haemodynamic response after blinded stress assessment of moderate aortic stenosis. EuroIntervention. Published 16 March 2026. doi:10.4244/eij-d-25-01006

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