Treadmill Stress Test in Patients With Asymptomatic Severe Aortic Stenosis
Year: 2026
Type: article
Abstract: Importance: In patients with asymptomatic severe aortic stenosis (AS), exercise stress testing is recommended to unmask symptoms and guide the timing of intervention, yet it is infrequently used in clinical practice. This registry-based follow-up of the Evaluation of TAVR Compared to Surveillance for Patients With Asymptomatic Severe Aortic Stenosis (EARLY TAVR) trial evaluates how treadmill stress testing (TST), used during screening for EARLY TAVR to confirm asymptomatic status, informed subsequent aortic valve replacement and clinical outcomes. Objective: To evaluate clinical outcomes in patients with asymptomatic severe AS and a positive TST result and to identify predictors of a positive TST result. Design, Setting, and Participants: This prespecified TST registry of the EARLY TAVR trial involved 75 clinical sites across the US. Between July 2017 and December 2021, apparently asymptomatic patients with severe AS underwent standardized TST. Those with normal TST results were randomized to transcatheter aortic valve replacement or clinical surveillance, whereas those with positive TST results were invited to enroll in a prospective registry and were followed up with through 2 years. Of 1250 patients screened, 962 met trial criteria. Of these, 816 (84.8%) had a normal TST result and 146 (15.2%) had a positive TST result. Of these, 105 consented to enroll in the EARLY TAVR Treadmill Registry. Data were analyzed from August 2025 to January 2026. Exposure: Positive TST result. Main Outcomes and Measures: TST-related safety, 2-year all-cause mortality, and rates of subsequent aortic valve replacement (AVR). Baseline predictors of a positive TST result were identified using multivariable logistic regression models. Results: Of the 105 patients included in the present analysis, the mean (SD) age was 76.1 (6.5) years, and 80 participants (76.2%) were male. TST was found to be safe, with no reported deaths, syncope, or cardioversions. Multivariable baseline predictors of a positive TST included higher peak velocity, lower ejection fraction, prior coronary artery bypass, and prior stroke. The 2-year Kaplan-Meier rate for all-cause mortality was 5.7%. Among patients with positive TST results, the rates of AVR at 1 and 2 years were 79.9% and 85.9%, respectively. Rates of mortality and AVR were similar for patients who had a class I indication for AVR (symptoms during testing) and those with a class IIa indication (drop in systolic blood pressure). Conclusions and Relevance: In patients with asymptomatic severe AS, TST was found to be safe and identified symptoms and AVR indication in approximately 15% of patients. However, 20% of those patients remained untreated at 1 year, despite having an indication for prompt treatment. Trial Registration: ClinicalTrials.gov Identifier: NCT03042104.
Source: JAMA Cardiology
Authors: Philippe Généreux, Allan Schwartz, Brian R. Lindman, Adnan Chhatriwalla, Stephen Ramee, Vasilis Babaliaros, Richard Schwartz, Tej Sheth, William F. Fearon, Paul Sorajja, Thomas Beaver, J. Bradley Oldemeyer, Andrei Pop, Santiago Garcia, Jeffrey Southard, Stephen H. Bailey, Wenhao Li, David J. Cohen, Philippe Pibarot, Martin B. Leon, EARLY TAVR Trial and Registry Investigators, E L Robinson, Y Zhao
Institutions: Morristown Medical Center, NewYork–Presbyterian Hospital, Columbia University Irving Medical Center, Vanderbilt University Medical Center, Saint Luke's Hospital, Ochsner Medical Center, Emory University, NYU Langone Health, New York University, Hamilton Health Sciences, VA Palo Alto Health Care System, Stanford Cardiovascular Institute, Stanford University, Minneapolis Heart Institute Foundation, University of Florida Health, University of Florida, University of Colorado Health, Alexian Brothers Health System, Alexian Brothers Medical Center, Christ Hospital, University of California Davis Medical Center, Allegheny Health Network, Allegheny General Hospital, Edwards Lifesciences (United States), St. Francis Hospital, Cardiovascular Research Foundation, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7170081767