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Valvular & structural heart diseaseCohort study

Risk stratification in aortic stenosis: exercise haemodynamics to refine risk in early cardiac damage stages

Eur Heart J Cardiovasc ImagingPublished

  • cohort of consecutive patients undergoing cardiopulmonary exercise testing with echocardiography
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Authors' conclusion

In patients with ≥ moderate AS and discordant symptoms, cardiac damage stage and exPHT independently refined HF risk stratification. ExPHT provides incremental prognostic value in early damage stages (1-2), representing over half of the cohort, supporting a stepwise approach of routine damage staging with selective with exPHT assessment with exercise echocardiography in this subgroup to guide more personalized management and potentially optimize AVR timing.

Study context

Population
Patients with ≥ moderate aortic stenosis (AS) (symptomatic moderate AS and asymptomatic severe AS)consecutive patients with ≥ moderate AS (74 ± 10 years, 32% women, 56% severe AS) · Stage 0 93 · Stage 1 (LV damage) 135 · Stage 2 (LA/mitral damage) 135 · Stage 3-4 (pulmonary vasculature/tricuspid or RV damage) 73
Participants
436 patients
Exposure
cardiac damage stage and exercise-induced pulmonary hypertension (exPHT) for heart failure (HF) outcomes
  • Stage 0n = 93
  • Stage 1n = 135
  • Stage 2n = 135
  • Stage 3-4n = 73
Outcome
HF death and HF hospitalizations
Follow-up
Median 37 months

Main finding

As reported in the abstract

Hazard ratio (CI)P value
per stage increasecardiac damage stage; adjusted for age, AS severity, and aortic valve replacement
1.51(1.26–1.82)
P < 0.001
exPHTadjusted for age, AS severity, and aortic valve replacement
2.36(1.10–5.07)
P = 0.03

Per stage increase, as printed

patients who met the primary endpoint
65

Observational data: associations, not effects.

Further findings

HF events in early-stage disease (stages 1-2)

ComparisonHR (CI)P value
exPHT · stages 1-2; approximately five-fold higher risk4.45 (1.58–12.59)P < 0.01
  • HF events in early-stage disease (stages 1-2): subgroup: early-stage disease (stages 1-2)

Exercise capacity and haemodynamics by cardiac damage stage

Higher stages were associated with worse exercise capacity and haemodynamics

Original publication

Risk stratification in aortic stenosis: exercise haemodynamics to refine risk in early cardiac damage stages. Eur Heart J Cardiovasc Imaging. Published 3 July 2026. doi:10.1093/ehjci/jeag174
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Summarised from the published abstract; every number is checked against it