{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T18:09:17Z","timestamp":1791223757918,"version":"4.1.0"},"reference-count":28,"publisher":"BMJ","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"published-print":{"date-parts":[[2001,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To determine the prognostic value of exercise testing, valve area, and maximum transaortic pressure gradient in asymptomatic patients with aortic valve stenosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>SETTING<\/jats:title>\n                    <jats:p>The outpatient service of a tertiary referral centre for cardiology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DESIGN<\/jats:title>\n                    <jats:p>Prospective clinical study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PATIENT S<\/jats:title>\n                    <jats:p>\n                      66 consecutive patients with isolated severe aortic stenosis (aortic valve area \u2a7d\u20091.0\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      ) were selected over a 58 month period. Mean (SD) follow up was 14.77 (11.93) months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>INTERVENTIONS<\/jats:title>\n                    <jats:p>At the initial visit Doppler echocardiography and exercise testing were performed to evaluate ST segment depression and the development of symptoms of aortic stenosis, ventricular arrhythmia, or inadequate rise of systolic blood pressure during exercise. Follow up clinical examinations were performed every three months thereafter to record the onset of symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MAIN OUTCOME MEASURES<\/jats:title>\n                    <jats:p>Sudden death or the development of symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Eight patients developed dizziness during exercise testing but made a rapid and spontaneous recovery. No other complications of exercise testing occurred. Survival curves, with or without the occurrence of end point events for the variables studied, showed significant differences for positive versus negative exercise testing (p\u2009=\u20090.0001) and aortic valve area &lt;\u20090.7\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      <jats:italic>v<\/jats:italic>\n                      \u2a7e\u20090.7\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      (p\u2009=\u20090.0021). There was no relation between the end points and transaortic gradient (p\u2009=\u20090.6882). In multivariate analysis, a hazard ratio of 7.43 was calculated for patients with a positive versus a negative exercise stress test. Although asymptomatic in daily life, 6% of the patients (4\/66) experienced sudden death; all these had a positive exercise test and an aortic valve area of \u2a7d\u20090.6\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Exercise testing is safe and is of prognostic value in asymptomatic patients with aortic stenosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/heart.86.4.381","type":"journal-article","created":{"date-parts":[[2002,7,27]],"date-time":"2002-07-27T06:37:40Z","timestamp":1027751860000},"page":"381-386","source":"Crossref","is-referenced-by-count":253,"title":["Treatment decision in asymptomatic aortic valve stenosis: role of exercise testing"],"prefix":"10.1136","volume":"86","author":[{"given":"M C M","family":"Amato","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P J","family":"Moffa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K E","family":"Werner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J A F","family":"Ramires","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2001,10,1]]},"reference":[{"key":"2025101714101126000_86.4.381.1","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/0735-1097(90)90352-P","article-title":"Ultrasonic aortic valve decalcification: serial Doppler echocardiographic follow-up.","volume":"16","author":"Freeman","year":"1990","journal-title":"J Am Coll Cardiol"},{"key":"2025101714101126000_86.4.381.2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(88)91317-3"},{"key":"2025101714101126000_86.4.381.3","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1093\/eurheartj\/9.suppl_E.57","article-title":"The natural history of aortic valve stenosis.","volume":"9","author":"Horstkotte","year":"1988","journal-title":"Eur Heart J"},{"key":"2025101714101126000_86.4.381.4","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1093\/oxfordjournals.eurheartj.a062307","article-title":"Spontaneous course of aortic valve disease.","volume":"8","author":"Turina","year":"1987","journal-title":"Eur Heart J"},{"key":"2025101714101126000_86.4.381.5","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(90)90234-G"},{"key":"2025101714101126000_86.4.381.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)00454-9"},{"key":"2025101714101126000_86.4.381.7","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1111\/j.0954-6820.1958.tb10368.x","article-title":"Isolated aortic stenosis: the late prognosis.","volume":"160","author":"Olesen","year":"1958","journal-title":"Acta Med Scand"},{"key":"2025101714101126000_86.4.381.8","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.35.1.41"},{"key":"2025101714101126000_86.4.381.9","doi-asserted-by":"publisher","DOI":"10.1378\/chest.92.1.40"},{"key":"2025101714101126000_86.4.381.10","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(75)90005-3"},{"key":"2025101714101126000_86.4.381.11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199608083350607"},{"key":"2025101714101126000_86.4.381.12","first-page":"381","article-title":"[Immediate and long-term prognosis of patients with porcine bioprosthesis]","volume":"51","author":"Amato","year":"1988","journal-title":"Arq Bras Cardiol"},{"key":"2025101714101126000_86.4.381.13","first-page":"299","article-title":"[Implant of Starr-Edwards mechanical prosthesis for more than 15 years: analysis of 34 cases.]","volume":"48","author":"Amato","year":"1987","journal-title":"Arq Bras Cardiol"},{"key":"2025101714101126000_86.4.381.14","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.95.9.2262"},{"key":"2025101714101126000_86.4.381.15","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(94)90233-X"},{"key":"2025101714101126000_86.4.381.16","unstructured":"Ellestad MH (1975) Stress testing: principles and practice. 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