The value of cardiopulmonary exercise testing in individuals with apparently asymptomatic severe aortic stenosis: A pilot study
Risk stratification in asymptomatic patients with severe aortic stenosis (AS) is based on exercise test results. However, differentiating between pathological and physiological breathlessness during exercise is sometimes challenging. Cardiopulmonary exercise testing (CPET) may improve quantification...
Saved in:
| Published in | Archives of cardiovascular diseases Vol. 107; no. 10; pp. 519 - 528 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Netherlands
Elsevier Masson SAS
01.10.2014
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 1875-2136 1875-2128 1875-2128 |
| DOI | 10.1016/j.acvd.2014.06.003 |
Cover
| Abstract | Risk stratification in asymptomatic patients with severe aortic stenosis (AS) is based on exercise test results. However, differentiating between pathological and physiological breathlessness during exercise is sometimes challenging. Cardiopulmonary exercise testing (CPET) may improve quantification of cardiopulmonary exercise capacity in patients with valve diseases.
To assess the ability of CPET to detect abnormal responses to exercise and a clinical endpoint (occurrence of European Society of Cardiology guidelines surgical class I triggers).
Forty-three consecutive patients (mean age 69±13 years; 31 men) with no reported symptoms and severe AS (aortic valve surface area<1cm2 or indexed aortic valve surface area ≤0.6cm2/m2) prospectively underwent symptom-limited CPET.
Twelve (28%) patients had an abnormal exercise test (AET) with symptoms (abnormal dyspnoea n=11; angina n=1). Both VE/VCO2 slope>34 (hazard ratio [HR]=5.76, 95% confidence interval [CI] 1.086–30.587; P=0.04) and peak VO2≤14mL/kg/min (HR 6.01, 95% CI 1.153–31.275; P=0.03) were independently associated with an AET. Furthermore, VE/VCO2 slope>34 (HR 3.681, 95% CI 1.318–10.286; P=0.013) and peak VO2≤14mL/kg/min (HR 3.058, 95% CI 1.074–8.713; P=0.036) were independent predictors of reaching the clinical endpoint.
Cardiopulmonary exercise testing is a useful tool for characterizing breathlessness during an exercise test in apparently asymptomatic patients with AS. Peak VO2≤14mL/kg/min and VE/VCO2 slope>34 were associated with an AET and the occurrence of European Society of Cardiology guideline surgical class I triggers.
L’épreuve d’effort en cas de sténose aortique serrée asymptomatique d’après l’interrogatoire vise à démasquer la survenue de symptômes. Néanmoins, il est parfois difficile de différentier un essoufflement à l’effort pathologique d’un essoufflement physiologique.
Évaluer la capacité de l’épreuve d’effort cardiorespiratoire chez les patients atteints d’une sténose aortique serrée asymptomatique d’après l’interrogatoire à (i) détecter une réponse anormale à l’effort, (ii) à prédire un objectif clinique (la survenue d’une indication opératoire de classe I selon la Société européenne de cardiologie).
Une épreuve d’effort cardiorespiratoire a été réalisée prospectivement chez quarante-trois patients consécutifs (d’âge moyen 69±13ans ; 32 hommes) porteurs d’une sténose aortique serrée (surface aortique<1 cm2 ou surface aortique indexée≤0,6 cm2/m2) sans symptôme rapporté à l’interrogatoire.
Douze patients (28 %) ont présenté des symptômes lors du test d’effort (dyspnée anormale n=11 ; angor n=1). Une pente VE/VCO2>34 (hazard ratio [HR] 5,76, 95 % intervalle de confiance [IC] 1,086–30,587 ; p=0,04) et un pic de VO2≤14mL/kg/min (HR 6,01, 95 % IC 1,153–31,275 ; p=0,03) étaient indépendamment associés avec la survenue de symptômes lors de l’épreuve d’effort. De plus, une pente VE/VCO2>34 (HR 3,681, 95 % IC 1,318–10,286 ; p=0,013) et un pic de VO2≤14mL/kg/min (HR 3,058, 95 % IC 1,074–8,713 ; p=0,036) étaient associés à une indication chirurgicale de classe I.
L’épreuve d’effort cardiorespiratoire peut s’avérer utile pour définir le caractère pathologique d’une dyspnée lors d’un test d’effort dans le cadre d’une sténose aortique serrée censée être asymptomatique selon l’interrogatoire. Un pic de VO2≤14mL/kg/min et une pente VE/VCO2>34 sont associés à la survenue de symptôme lors du test d’effort et à une indication chirurgicale de classe I de l’ESC. |
|---|---|
| AbstractList | Risk stratification in asymptomatic patients with severe aortic stenosis (AS) is based on exercise test results. However, differentiating between pathological and physiological breathlessness during exercise is sometimes challenging. Cardiopulmonary exercise testing (CPET) may improve quantification of cardiopulmonary exercise capacity in patients with valve diseases.
To assess the ability of CPET to detect abnormal responses to exercise and a clinical endpoint (occurrence of European Society of Cardiology guidelines surgical class I triggers).
Forty-three consecutive patients (mean age 69±13 years; 31 men) with no reported symptoms and severe AS (aortic valve surface area<1 cm2 or indexed aortic valve surface area ≤0.6 cm2/m2) prospectively underwent symptom-limited CPET.
Twelve (28%) patients had an abnormal exercise test (AET) with symptoms (abnormal dyspnoea n=11; angina n=1). Both VE/VCO2 slope>34 (hazard ratio [HR]=5.76, 95% confidence interval [CI] 1.086-30.587; P=0.04) and peak VO2≤14 mL/kg/min (HR 6.01, 95% CI 1.153-31.275; P=0.03) were independently associated with an AET. Furthermore, VE/VCO2 slope>34 (HR 3.681, 95% CI 1.318-10.286; P=0.013) and peak VO2≤14 mL/kg/min (HR 3.058, 95% CI 1.074-8.713; P=0.036) were independent predictors of reaching the clinical endpoint.
Cardiopulmonary exercise testing is a useful tool for characterizing breathlessness during an exercise test in apparently asymptomatic patients with AS. Peak VO2≤14 mL/kg/min and VE/VCO2 slope>34 were associated with an AET and the occurrence of European Society of Cardiology guideline surgical class I triggers. Risk stratification in asymptomatic patients with severe aortic stenosis (AS) is based on exercise test results. However, differentiating between pathological and physiological breathlessness during exercise is sometimes challenging. Cardiopulmonary exercise testing (CPET) may improve quantification of cardiopulmonary exercise capacity in patients with valve diseases. To assess the ability of CPET to detect abnormal responses to exercise and a clinical endpoint (occurrence of European Society of Cardiology guidelines surgical class I triggers). Forty-three consecutive patients (mean age 69±13 years; 31 men) with no reported symptoms and severe AS (aortic valve surface area<1cm2 or indexed aortic valve surface area ≤0.6cm2/m2) prospectively underwent symptom-limited CPET. Twelve (28%) patients had an abnormal exercise test (AET) with symptoms (abnormal dyspnoea n=11; angina n=1). Both VE/VCO2 slope>34 (hazard ratio [HR]=5.76, 95% confidence interval [CI] 1.086–30.587; P=0.04) and peak VO2≤14mL/kg/min (HR 6.01, 95% CI 1.153–31.275; P=0.03) were independently associated with an AET. Furthermore, VE/VCO2 slope>34 (HR 3.681, 95% CI 1.318–10.286; P=0.013) and peak VO2≤14mL/kg/min (HR 3.058, 95% CI 1.074–8.713; P=0.036) were independent predictors of reaching the clinical endpoint. Cardiopulmonary exercise testing is a useful tool for characterizing breathlessness during an exercise test in apparently asymptomatic patients with AS. Peak VO2≤14mL/kg/min and VE/VCO2 slope>34 were associated with an AET and the occurrence of European Society of Cardiology guideline surgical class I triggers. L’épreuve d’effort en cas de sténose aortique serrée asymptomatique d’après l’interrogatoire vise à démasquer la survenue de symptômes. Néanmoins, il est parfois difficile de différentier un essoufflement à l’effort pathologique d’un essoufflement physiologique. Évaluer la capacité de l’épreuve d’effort cardiorespiratoire chez les patients atteints d’une sténose aortique serrée asymptomatique d’après l’interrogatoire à (i) détecter une réponse anormale à l’effort, (ii) à prédire un objectif clinique (la survenue d’une indication opératoire de classe I selon la Société européenne de cardiologie). Une épreuve d’effort cardiorespiratoire a été réalisée prospectivement chez quarante-trois patients consécutifs (d’âge moyen 69±13ans ; 32 hommes) porteurs d’une sténose aortique serrée (surface aortique<1 cm2 ou surface aortique indexée≤0,6 cm2/m2) sans symptôme rapporté à l’interrogatoire. Douze patients (28 %) ont présenté des symptômes lors du test d’effort (dyspnée anormale n=11 ; angor n=1). Une pente VE/VCO2>34 (hazard ratio [HR] 5,76, 95 % intervalle de confiance [IC] 1,086–30,587 ; p=0,04) et un pic de VO2≤14mL/kg/min (HR 6,01, 95 % IC 1,153–31,275 ; p=0,03) étaient indépendamment associés avec la survenue de symptômes lors de l’épreuve d’effort. De plus, une pente VE/VCO2>34 (HR 3,681, 95 % IC 1,318–10,286 ; p=0,013) et un pic de VO2≤14mL/kg/min (HR 3,058, 95 % IC 1,074–8,713 ; p=0,036) étaient associés à une indication chirurgicale de classe I. L’épreuve d’effort cardiorespiratoire peut s’avérer utile pour définir le caractère pathologique d’une dyspnée lors d’un test d’effort dans le cadre d’une sténose aortique serrée censée être asymptomatique selon l’interrogatoire. Un pic de VO2≤14mL/kg/min et une pente VE/VCO2>34 sont associés à la survenue de symptôme lors du test d’effort et à une indication chirurgicale de classe I de l’ESC. Risk stratification in asymptomatic patients with severe aortic stenosis (AS) is based on exercise test results. However, differentiating between pathological and physiological breathlessness during exercise is sometimes challenging. Cardiopulmonary exercise testing (CPET) may improve quantification of cardiopulmonary exercise capacity in patients with valve diseases.BACKGROUNDRisk stratification in asymptomatic patients with severe aortic stenosis (AS) is based on exercise test results. However, differentiating between pathological and physiological breathlessness during exercise is sometimes challenging. Cardiopulmonary exercise testing (CPET) may improve quantification of cardiopulmonary exercise capacity in patients with valve diseases.To assess the ability of CPET to detect abnormal responses to exercise and a clinical endpoint (occurrence of European Society of Cardiology guidelines surgical class I triggers).AIMSTo assess the ability of CPET to detect abnormal responses to exercise and a clinical endpoint (occurrence of European Society of Cardiology guidelines surgical class I triggers).Forty-three consecutive patients (mean age 69±13 years; 31 men) with no reported symptoms and severe AS (aortic valve surface area<1 cm2 or indexed aortic valve surface area ≤0.6 cm2/m2) prospectively underwent symptom-limited CPET.METHODSForty-three consecutive patients (mean age 69±13 years; 31 men) with no reported symptoms and severe AS (aortic valve surface area<1 cm2 or indexed aortic valve surface area ≤0.6 cm2/m2) prospectively underwent symptom-limited CPET.Twelve (28%) patients had an abnormal exercise test (AET) with symptoms (abnormal dyspnoea n=11; angina n=1). Both VE/VCO2 slope>34 (hazard ratio [HR]=5.76, 95% confidence interval [CI] 1.086-30.587; P=0.04) and peak VO2≤14 mL/kg/min (HR 6.01, 95% CI 1.153-31.275; P=0.03) were independently associated with an AET. Furthermore, VE/VCO2 slope>34 (HR 3.681, 95% CI 1.318-10.286; P=0.013) and peak VO2≤14 mL/kg/min (HR 3.058, 95% CI 1.074-8.713; P=0.036) were independent predictors of reaching the clinical endpoint.RESULTSTwelve (28%) patients had an abnormal exercise test (AET) with symptoms (abnormal dyspnoea n=11; angina n=1). Both VE/VCO2 slope>34 (hazard ratio [HR]=5.76, 95% confidence interval [CI] 1.086-30.587; P=0.04) and peak VO2≤14 mL/kg/min (HR 6.01, 95% CI 1.153-31.275; P=0.03) were independently associated with an AET. Furthermore, VE/VCO2 slope>34 (HR 3.681, 95% CI 1.318-10.286; P=0.013) and peak VO2≤14 mL/kg/min (HR 3.058, 95% CI 1.074-8.713; P=0.036) were independent predictors of reaching the clinical endpoint.Cardiopulmonary exercise testing is a useful tool for characterizing breathlessness during an exercise test in apparently asymptomatic patients with AS. Peak VO2≤14 mL/kg/min and VE/VCO2 slope>34 were associated with an AET and the occurrence of European Society of Cardiology guideline surgical class I triggers.CONCLUSIONSCardiopulmonary exercise testing is a useful tool for characterizing breathlessness during an exercise test in apparently asymptomatic patients with AS. Peak VO2≤14 mL/kg/min and VE/VCO2 slope>34 were associated with an AET and the occurrence of European Society of Cardiology guideline surgical class I triggers. Summary Background Risk stratification in asymptomatic patients with severe aortic stenosis (AS) is based on exercise test results. However, differentiating between pathological and physiological breathlessness during exercise is sometimes challenging. Cardiopulmonary exercise testing (CPET) may improve quantification of cardiopulmonary exercise capacity in patients with valve diseases. Aims To assess the ability of CPET to detect abnormal responses to exercise and a clinical endpoint (occurrence of European Society of Cardiology guidelines surgical class I triggers). Methods Forty-three consecutive patients (mean age 69 ± 13 years; 31 men) with no reported symptoms and severe AS (aortic valve surface area < 1 cm2 or indexed aortic valve surface area ≤ 0.6 cm2 /m2 ) prospectively underwent symptom-limited CPET. Results Twelve (28%) patients had an abnormal exercise test (AET) with symptoms (abnormal dyspnoea n = 11; angina n = 1). Both VE/VCO2 slope > 34 (hazard ratio [HR] = 5.76, 95% confidence interval [CI] 1.086–30.587; P = 0.04) and peak VO2 ≤ 14 mL/kg/min (HR 6.01, 95% CI 1.153–31.275; P = 0.03) were independently associated with an AET. Furthermore, VE/VCO2 slope > 34 (HR 3.681, 95% CI 1.318–10.286; P = 0.013) and peak VO2 ≤ 14 mL/kg/min (HR 3.058, 95% CI 1.074–8.713; P = 0.036) were independent predictors of reaching the clinical endpoint. Conclusions Cardiopulmonary exercise testing is a useful tool for characterizing breathlessness during an exercise test in apparently asymptomatic patients with AS. Peak VO2 ≤ 14 mL/kg/min and VE/VCO2 slope > 34 were associated with an AET and the occurrence of European Society of Cardiology guideline surgical class I triggers. |
| Author | Fayad, Nader Jeu, Antoine Choquet, Dominique Tribouilloy, Christophe Szymanski, Catherine Levy, Franck Peltier, Marcel Malaquin, Dorothée |
| Author_xml | – sequence: 1 givenname: Franck orcidid: 0000-0002-0514-931X surname: Levy fullname: Levy, Franck – sequence: 2 givenname: Nader surname: Fayad fullname: Fayad, Nader – sequence: 3 givenname: Antoine surname: Jeu fullname: Jeu, Antoine – sequence: 4 givenname: Dominique surname: Choquet fullname: Choquet, Dominique – sequence: 5 givenname: Catherine surname: Szymanski fullname: Szymanski, Catherine – sequence: 6 givenname: Dorothée surname: Malaquin fullname: Malaquin, Dorothée – sequence: 7 givenname: Marcel surname: Peltier fullname: Peltier, Marcel – sequence: 8 givenname: Christophe surname: Tribouilloy fullname: Tribouilloy, Christophe email: tribouilloy.christophe@chu-amiens.fr |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25240605$$D View this record in MEDLINE/PubMed |
| BookMark | eNqFkktrFTEcxQep2Id-AReSpZs7Jpk8ZooIpfiCggvrOuQm_7G5ziRjkrk6K7-6GW_tomCFQB6c3wk5J6fVkQ8equo5wTXBRLza1drsbU0xYTUWNcbNo-qEtJJvKKHt0d26EcfVaUo7jAWVUjypjimnDAvMT6pf1zeA9nqYAYUeGR2tC9M8jMHruCD4CdG4BChDys5_Rc6XYd3e2VkPCf1w-QbpadIRfB4WpNMyTjmMOjuDEuwhAtIh_tll8CG5dI4u0OSGkMvJbJen1eO-OMGz2_ms-vLu7fXlh83Vp_cfLy-uNoYJmjdyC5gLg3knbCPBGmsla3vGWyq17IF2BhPDTYO3IBjvCGhgfMs4l63QrGvOqpcH3ymG73N5jRpdMjAM2kOYkyKCdh1vmpYX6Ytb6bwdwaopurGEof6GVgT0IDAxpBShv5MQrNZm1E6tzai1GYWFKs0UqL0HGZdLTsHnqN3wMPr6gEIJaO8gqmQceAPWRTBZ2eAext_cw83gvDN6-AYLpF2Yoy_RK6ISVVh9Xn_N-mkIw5g0rSwG5_82-N_tvwEVEtQC |
| CitedBy_id | crossref_primary_10_1016_j_jacc_2016_01_066 crossref_primary_10_1161_CIR_0000000000000406 crossref_primary_10_1093_ejcts_ezac119 crossref_primary_10_15420_usc_2024_37 crossref_primary_10_1016_j_ijcard_2016_10_070 crossref_primary_10_1016_j_acvd_2018_03_002 crossref_primary_10_1016_j_ahj_2016_06_012 crossref_primary_10_1016_S1773_035X_17_30237_X crossref_primary_10_1093_eurheartj_ehw180 crossref_primary_10_1136_openhrt_2024_003084 crossref_primary_10_1016_j_acvd_2018_07_001 crossref_primary_10_1016_j_recesp_2022_07_005 crossref_primary_10_1016_j_recesp_2022_10_002 crossref_primary_10_15420_icr_2021_04 crossref_primary_10_1016_j_jacc_2016_02_057 crossref_primary_10_1016_j_echo_2017_04_005 crossref_primary_10_1016_j_rec_2022_07_013 crossref_primary_10_1016_j_ahj_2016_06_013 crossref_primary_10_1161_CIRCULATIONAHA_117_029575 crossref_primary_10_1016_j_cpcardiol_2017_12_001 crossref_primary_10_1016_j_tcm_2020_10_002 crossref_primary_10_1016_j_rec_2022_10_011 crossref_primary_10_1186_s44156_025_00070_7 crossref_primary_10_1161_CIRCULATIONAHA_116_025457 crossref_primary_10_1001_jamacardio_2020_2497 crossref_primary_10_1161_JAHA_115_003146 crossref_primary_10_3390_jcm11174983 |
| Cites_doi | 10.1136/hrt.2009.181644 10.3810/pgm.2010.11.2225 10.1136/heart.86.4.381 10.1161/01.CIR.101.24.2803 10.1161/01.CIR.103.7.967 10.1161/CIRCULATIONAHA.104.495903 10.1093/eurheartj/ehq076 10.1016/j.amjcard.2009.05.044 10.1016/S0894-7317(89)80014-8 10.1016/j.jacc.2004.10.081 10.1016/j.amjmed.2012.01.012 10.5114/aoms.2012.32409 10.1016/0002-9149(91)90281-O 10.1161/01.CIR.72.4.810 10.1016/j.ejheart.2008.08.010 10.1093/eurheartj/ehi250 10.1016/j.jacc.2006.02.043 10.1161/01.CIR.83.3.778 10.1016/j.echo.2005.10.005 10.1161/01.CIR.96.7.2221 10.1093/eurheartj/ehs109 10.1111/j.1540-8175.2007.00501.x 10.1016/j.jacc.2006.05.021 10.1161/CIRCULATIONAHA.112.110460 10.1161/01.CIR.0000041428.99427.06 |
| ContentType | Journal Article |
| Copyright | 2014 Elsevier Masson SAS Elsevier Masson SAS Copyright © 2014 Elsevier Masson SAS. All rights reserved. |
| Copyright_xml | – notice: 2014 Elsevier Masson SAS – notice: Elsevier Masson SAS – notice: Copyright © 2014 Elsevier Masson SAS. All rights reserved. |
| DBID | 6I. AAFTH AAYXX CITATION CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1016/j.acvd.2014.06.003 |
| DatabaseName | ScienceDirect Open Access Titles Elsevier:ScienceDirect:Open Access CrossRef Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | CrossRef MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE MEDLINE - Academic |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: EIF name: MEDLINE url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search sourceTypes: Index Database |
| DeliveryMethod | fulltext_linktorsrc |
| Discipline | Medicine |
| DocumentTitleAlternate | Apport de l’épreuve d’effort cardiorespiratoire dans l’évaluation des patients porteurs d’une sténose aortique serrée asymptomatique : une étude préliminaire |
| EISSN | 1875-2128 |
| EndPage | 528 |
| ExternalDocumentID | 25240605 10_1016_j_acvd_2014_06_003 S1875213614001387 1_s2_0_S1875213614001387 |
| Genre | Journal Article |
| GroupedDBID | --- --K --M .1- .FO .~1 0R~ 1B1 1P~ 1~. 1~5 23M 4.4 457 4G. 53G 5GY 5VS 6J9 7-5 71M 8P~ AAEDT AAEDW AAFWJ AAIKJ AAKOC AALRI AAOAW AAQFI AATTM AAXKI AAXUO AAYWO ABBQC ABFNM ABFRF ABJNI ABMAC ABMZM ABWVN ABXDB ACDAQ ACGFO ACGFS ACIEU ACRLP ACRPL ACVFH ADBBV ADCNI ADEZE ADMUD ADNMO ADVLN AEBSH AEFWE AEIPS AEKER AENEX AEUPX AEVXI AEXQZ AFJKZ AFPUW AFRHN AFTJW AFXIZ AGCQF AGHFR AGUBO AGYEJ AIEXJ AIGII AIIUN AIKHN AITUG AJRQY AJUYK AKBMS AKRWK AKYEP ALMA_UNASSIGNED_HOLDINGS AMRAJ ANKPU ANZVX APXCP AXJTR BAWUL BKOJK BLXMC BNPGV CS3 DIK EBS EFJIC EFKBS EJD EO9 EP2 EP3 F5P FDB FEDTE FIRID FNPLU FYGXN GBLVA HVGLF HZ~ IXB J1W KOM LN9 M41 MO0 N9A O-L O9- OAUVE OA~ OK1 OL0 OZT P-8 P-9 PC. Q38 ROL SDF SDG SEM SES SPCBC SSH SSZ T5K UNMZH Z5R ~G- 0SF 6I. AACTN AAFTH ABVKL AFCTW AFKWA AJOXV AMFUW NCXOZ RIG AAIAV ABLVK ABYKQ AJBFU EFLBG LCYCR AAYXX AGRNS CITATION CGR CUY CVF ECM EIF NPM 7X8 ACLOT ~HD |
| ID | FETCH-LOGICAL-c462t-7be056c0596d37edcdd748f45827a7fe29c01c5c30be64591eae45b455786a493 |
| IEDL.DBID | IXB |
| ISSN | 1875-2136 1875-2128 |
| IngestDate | Sun Sep 28 06:38:43 EDT 2025 Thu Apr 03 07:03:26 EDT 2025 Tue Jul 01 00:49:45 EDT 2025 Thu Apr 24 22:58:39 EDT 2025 Fri Feb 23 02:20:48 EST 2024 Sun Feb 23 10:18:54 EST 2025 Tue Aug 26 19:49:45 EDT 2025 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 10 |
| Keywords | CPET Épreuve d’effort cardiorespiratoire ROC VE AET AS Asymptomatic aortic stenosis Cardiopulmonary exercise testing Test d’effort anormal VCO2 VO2 Sténose aortique serrée asymptomatique AVR RER Abnormal exercise test VO 2 Aortic Stenosis Aortic Valve Replacement Oxygen Uptake VCO 2 Ventilation Respiratory Exchange Ratio Carbon Dioxide Output Receiver Operating Characteristic |
| Language | English |
| License | http://www.elsevier.com/open-access/userlicense/1.0 Copyright © 2014 Elsevier Masson SAS. All rights reserved. |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c462t-7be056c0596d37edcdd748f45827a7fe29c01c5c30be64591eae45b455786a493 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ORCID | 0000-0002-0514-931X |
| OpenAccessLink | https://www.sciencedirect.com/science/article/pii/S1875213614001387 |
| PMID | 25240605 |
| PQID | 1629953385 |
| PQPubID | 23479 |
| PageCount | 10 |
| ParticipantIDs | proquest_miscellaneous_1629953385 pubmed_primary_25240605 crossref_primary_10_1016_j_acvd_2014_06_003 crossref_citationtrail_10_1016_j_acvd_2014_06_003 elsevier_sciencedirect_doi_10_1016_j_acvd_2014_06_003 elsevier_clinicalkeyesjournals_1_s2_0_S1875213614001387 elsevier_clinicalkey_doi_10_1016_j_acvd_2014_06_003 |
| ProviderPackageCode | CITATION AAYXX |
| PublicationCentury | 2000 |
| PublicationDate | 2014-10-01 |
| PublicationDateYYYYMMDD | 2014-10-01 |
| PublicationDate_xml | – month: 10 year: 2014 text: 2014-10-01 day: 01 |
| PublicationDecade | 2010 |
| PublicationPlace | Netherlands |
| PublicationPlace_xml | – name: Netherlands |
| PublicationTitle | Archives of cardiovascular diseases |
| PublicationTitleAlternate | Arch Cardiovasc Dis |
| PublicationYear | 2014 |
| Publisher | Elsevier Masson SAS |
| Publisher_xml | – name: Elsevier Masson SAS |
| References | Vahanian, Baumgartner, Bax (bib0075) 2007; 28 Das, Rimington, McGrane, Chambers (bib0100) 2001; 37 Olaf, Debora, Ricarda (bib0025) 2012; 8 Mancini, Eisen, Kussmaul, Mull, Edmunds, Wilson (bib0030) 1991; 83 Messika-Zeitoun, Johnson, Nkomo (bib0020) 2006; 47 Pellikka, Sarano, Nishimura (bib0005) 2005; 111 Bonow, Carabello, Chatterjee (bib0015) 2006; 48 Skalski, Allison, Miller (bib0045) 2012; 126 Ukkonen, Burwash, Dafoe (bib0130) 2008; 10 Gitt, Wasserman, Kilkowski (bib0120) 2002; 106 Rajani, Rimington, Chambers (bib0105) 2010; 96 Das, Rimington, Chambers (bib0090) 2005; 26 Dhoble, Sarano, Kopecky, Thomas, Hayes, Allison (bib0040) 2012; 125 Forman, Myers, Lavie, Guazzi, Celli, Arena (bib0110) 2010; 122 Lang, Bierig, Devereux (bib0060) 2005; 18 Amato, Moffa, Werner, Ramires (bib0085) 2001; 86 Vahanian, Alfieri, Andreotti (bib0010) 2012; 33 Marechaux, Hachicha, Bellouin (bib0095) 2010; 31 Gibbons, Balady, Beasley (bib0070) 1997; 30 Marechaux, Ennezat, LeJemtel (bib0140) 2007; 24 Rafique, Biner, Ray, Forrester, Tolstrup, Siegel (bib0080) 2009; 104 Schiller, Shah, Crawford (bib0055) 1989; 2 Wasserman, Zhang, Gitt (bib0135) 1997; 96 Briand, Dumesnil, Kadem (bib0065) 2005; 46 Kleber, Vietzke, Wernecke (bib0125) 2000; 101 Ponikowski, Francis, Piepoli (bib0035) 2001; 103 Clyne, Arrighi, Maron, Dilsizian, Bonow, Cannon (bib0115) 1991; 68 Skjaerpe, Hegrenaes, Hatle (bib0050) 1985; 72 Wasserman (10.1016/j.acvd.2014.06.003_bib0135) 1997; 96 Vahanian (10.1016/j.acvd.2014.06.003_bib0010) 2012; 33 Pellikka (10.1016/j.acvd.2014.06.003_bib0005) 2005; 111 Amato (10.1016/j.acvd.2014.06.003_bib0085) 2001; 86 Forman (10.1016/j.acvd.2014.06.003_bib0110) 2010; 122 Marechaux (10.1016/j.acvd.2014.06.003_bib0140) 2007; 24 Bonow (10.1016/j.acvd.2014.06.003_bib0015) 2006; 48 Ponikowski (10.1016/j.acvd.2014.06.003_bib0035) 2001; 103 Dhoble (10.1016/j.acvd.2014.06.003_bib0040) 2012; 125 Mancini (10.1016/j.acvd.2014.06.003_bib0030) 1991; 83 Skjaerpe (10.1016/j.acvd.2014.06.003_bib0050) 1985; 72 Messika-Zeitoun (10.1016/j.acvd.2014.06.003_bib0020) 2006; 47 Schiller (10.1016/j.acvd.2014.06.003_bib0055) 1989; 2 Briand (10.1016/j.acvd.2014.06.003_bib0065) 2005; 46 Gibbons (10.1016/j.acvd.2014.06.003_bib0070) 1997; 30 Kleber (10.1016/j.acvd.2014.06.003_bib0125) 2000; 101 Olaf (10.1016/j.acvd.2014.06.003_bib0025) 2012; 8 Das (10.1016/j.acvd.2014.06.003_bib0090) 2005; 26 Clyne (10.1016/j.acvd.2014.06.003_bib0115) 1991; 68 Skalski (10.1016/j.acvd.2014.06.003_bib0045) 2012; 126 Rafique (10.1016/j.acvd.2014.06.003_bib0080) 2009; 104 Das (10.1016/j.acvd.2014.06.003_bib0100) 2001; 37 Rajani (10.1016/j.acvd.2014.06.003_bib0105) 2010; 96 Lang (10.1016/j.acvd.2014.06.003_bib0060) 2005; 18 Marechaux (10.1016/j.acvd.2014.06.003_bib0095) 2010; 31 Gitt (10.1016/j.acvd.2014.06.003_bib0120) 2002; 106 Vahanian (10.1016/j.acvd.2014.06.003_bib0075) 2007; 28 Ukkonen (10.1016/j.acvd.2014.06.003_bib0130) 2008; 10 |
| References_xml | – volume: 8 start-page: 1018 year: 2012 end-page: 1026 ident: bib0025 article-title: Exercise tolerance in asymptomatic patients with moderate-severe valvular heart disease and preserved ejection fraction publication-title: Arch Med Sci – volume: 83 start-page: 778 year: 1991 end-page: 786 ident: bib0030 article-title: Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure publication-title: Circulation – volume: 122 start-page: 68 year: 2010 end-page: 86 ident: bib0110 article-title: Cardiopulmonary exercise testing: relevant but underused publication-title: Postgrad Med – volume: 33 start-page: 2451 year: 2012 end-page: 2496 ident: bib0010 article-title: Guidelines on the management of valvular heart disease (version 2012) publication-title: Eur Heart J – volume: 46 start-page: 291 year: 2005 end-page: 298 ident: bib0065 article-title: Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: implications for diagnosis and treatment publication-title: J Am Coll Cardiol – volume: 103 start-page: 967 year: 2001 end-page: 972 ident: bib0035 article-title: Enhanced ventilatory response to exercise in patients with chronic heart failure and preserved exercise tolerance: marker of abnormal cardiorespiratory reflex control and predictor of poor prognosis publication-title: Circulation – volume: 68 start-page: 1469 year: 1991 end-page: 1476 ident: bib0115 article-title: Systemic and left ventricular responses to exercise stress in asymptomatic patients with valvular aortic stenosis publication-title: Am J Cardiol – volume: 96 start-page: 2221 year: 1997 end-page: 2227 ident: bib0135 article-title: Lung function and exercise gas exchange in chronic heart failure publication-title: Circulation – volume: 125 start-page: 704 year: 2012 end-page: 708 ident: bib0040 article-title: Safety of symptom-limited cardiopulmonary exercise testing in patients with aortic stenosis publication-title: Am J Med – volume: 28 start-page: 230 year: 2007 end-page: 268 ident: bib0075 article-title: Guidelines on the management of valvular heart disease: the Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology publication-title: Eur Heart J – volume: 72 start-page: 810 year: 1985 end-page: 818 ident: bib0050 article-title: Noninvasive estimation of valve area in patients with aortic stenosis by Doppler ultrasound and two-dimensional echocardiography publication-title: Circulation – volume: 18 start-page: 1440 year: 2005 end-page: 1463 ident: bib0060 article-title: Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology publication-title: J Am Soc Echocardiogr – volume: 24 start-page: 955 year: 2007 end-page: 959 ident: bib0140 article-title: Left ventricular response to exercise in aortic stenosis: an exercise echocardiographic study publication-title: Echocardiography – volume: 111 start-page: 3290 year: 2005 end-page: 3295 ident: bib0005 article-title: Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up publication-title: Circulation – volume: 2 start-page: 358 year: 1989 end-page: 367 ident: bib0055 article-title: Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms publication-title: J Am Soc Echocardiogr – volume: 30 start-page: 260 year: 1997 end-page: 311 ident: bib0070 article-title: ACC/AHA Guidelines for Exercise Testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing) publication-title: J Am Coll Cardiol – volume: 104 start-page: 972 year: 2009 end-page: 977 ident: bib0080 article-title: Meta-analysis of prognostic value of stress testing in patients with asymptomatic severe aortic stenosis publication-title: Am J Cardiol – volume: 26 start-page: 1309 year: 2005 end-page: 1313 ident: bib0090 article-title: Exercise testing to stratify risk in aortic stenosis publication-title: Eur Heart J – volume: 86 start-page: 381 year: 2001 end-page: 386 ident: bib0085 article-title: Treatment decision in asymptomatic aortic valve stenosis: role of exercise testing publication-title: Heart – volume: 31 start-page: 1390 year: 2010 end-page: 1397 ident: bib0095 article-title: Usefulness of exercise-stress echocardiography for risk stratification of true asymptomatic patients with aortic valve stenosis publication-title: Eur Heart J – volume: 101 start-page: 2803 year: 2000 end-page: 2809 ident: bib0125 article-title: Impairment of ventilatory efficiency in heart failure: prognostic impact publication-title: Circulation – volume: 126 start-page: 2465 year: 2012 end-page: 2472 ident: bib0045 article-title: The safety of cardiopulmonary exercise testing in a population with high-risk cardiovascular diseases publication-title: Circulation – volume: 10 start-page: 1117 year: 2008 end-page: 1122 ident: bib0130 article-title: Is ventilatory efficiency (VE/VCO(2) slope) associated with right ventricular oxidative metabolism in patients with congestive heart failure? publication-title: Eur J Heart Fail – volume: 48 start-page: e1 year: 2006 end-page: e148 ident: bib0015 article-title: ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons publication-title: J Am Coll Cardiol – volume: 37 year: 2001 ident: bib0100 article-title: The value of treadmill exercise testing in apparently asymptomatic aortic stenosis publication-title: J Am Coll Cardiol – volume: 96 start-page: 689 year: 2010 end-page: 695 ident: bib0105 article-title: Treadmill exercise in apparently asymptomatic patients with moderate or severe aortic stenosis: relationship between cardiac index and revealed symptoms publication-title: Heart – volume: 47 start-page: 2521 year: 2006 end-page: 2527 ident: bib0020 article-title: Cardiopulmonary exercise testing determination of functional capacity in mitral regurgitation: physiologic and outcome implications publication-title: J Am Coll Cardiol – volume: 106 start-page: 3079 year: 2002 end-page: 3084 ident: bib0120 article-title: Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death publication-title: Circulation – volume: 96 start-page: 689 year: 2010 ident: 10.1016/j.acvd.2014.06.003_bib0105 article-title: Treadmill exercise in apparently asymptomatic patients with moderate or severe aortic stenosis: relationship between cardiac index and revealed symptoms publication-title: Heart doi: 10.1136/hrt.2009.181644 – volume: 30 start-page: 260 year: 1997 ident: 10.1016/j.acvd.2014.06.003_bib0070 article-title: ACC/AHA Guidelines for Exercise Testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing) publication-title: J Am Coll Cardiol – volume: 122 start-page: 68 year: 2010 ident: 10.1016/j.acvd.2014.06.003_bib0110 article-title: Cardiopulmonary exercise testing: relevant but underused publication-title: Postgrad Med doi: 10.3810/pgm.2010.11.2225 – volume: 86 start-page: 381 year: 2001 ident: 10.1016/j.acvd.2014.06.003_bib0085 article-title: Treatment decision in asymptomatic aortic valve stenosis: role of exercise testing publication-title: Heart doi: 10.1136/heart.86.4.381 – volume: 28 start-page: 230 year: 2007 ident: 10.1016/j.acvd.2014.06.003_bib0075 article-title: Guidelines on the management of valvular heart disease: the Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology publication-title: Eur Heart J – volume: 101 start-page: 2803 year: 2000 ident: 10.1016/j.acvd.2014.06.003_bib0125 article-title: Impairment of ventilatory efficiency in heart failure: prognostic impact publication-title: Circulation doi: 10.1161/01.CIR.101.24.2803 – volume: 103 start-page: 967 year: 2001 ident: 10.1016/j.acvd.2014.06.003_bib0035 article-title: Enhanced ventilatory response to exercise in patients with chronic heart failure and preserved exercise tolerance: marker of abnormal cardiorespiratory reflex control and predictor of poor prognosis publication-title: Circulation doi: 10.1161/01.CIR.103.7.967 – volume: 111 start-page: 3290 year: 2005 ident: 10.1016/j.acvd.2014.06.003_bib0005 article-title: Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.104.495903 – volume: 31 start-page: 1390 year: 2010 ident: 10.1016/j.acvd.2014.06.003_bib0095 article-title: Usefulness of exercise-stress echocardiography for risk stratification of true asymptomatic patients with aortic valve stenosis publication-title: Eur Heart J doi: 10.1093/eurheartj/ehq076 – volume: 104 start-page: 972 year: 2009 ident: 10.1016/j.acvd.2014.06.003_bib0080 article-title: Meta-analysis of prognostic value of stress testing in patients with asymptomatic severe aortic stenosis publication-title: Am J Cardiol doi: 10.1016/j.amjcard.2009.05.044 – volume: 2 start-page: 358 year: 1989 ident: 10.1016/j.acvd.2014.06.003_bib0055 article-title: Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms publication-title: J Am Soc Echocardiogr doi: 10.1016/S0894-7317(89)80014-8 – volume: 46 start-page: 291 year: 2005 ident: 10.1016/j.acvd.2014.06.003_bib0065 article-title: Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: implications for diagnosis and treatment publication-title: J Am Coll Cardiol doi: 10.1016/j.jacc.2004.10.081 – volume: 125 start-page: 704 year: 2012 ident: 10.1016/j.acvd.2014.06.003_bib0040 article-title: Safety of symptom-limited cardiopulmonary exercise testing in patients with aortic stenosis publication-title: Am J Med doi: 10.1016/j.amjmed.2012.01.012 – volume: 37 issue: Suppl. A year: 2001 ident: 10.1016/j.acvd.2014.06.003_bib0100 article-title: The value of treadmill exercise testing in apparently asymptomatic aortic stenosis publication-title: J Am Coll Cardiol – volume: 8 start-page: 1018 year: 2012 ident: 10.1016/j.acvd.2014.06.003_bib0025 article-title: Exercise tolerance in asymptomatic patients with moderate-severe valvular heart disease and preserved ejection fraction publication-title: Arch Med Sci doi: 10.5114/aoms.2012.32409 – volume: 68 start-page: 1469 year: 1991 ident: 10.1016/j.acvd.2014.06.003_bib0115 article-title: Systemic and left ventricular responses to exercise stress in asymptomatic patients with valvular aortic stenosis publication-title: Am J Cardiol doi: 10.1016/0002-9149(91)90281-O – volume: 72 start-page: 810 year: 1985 ident: 10.1016/j.acvd.2014.06.003_bib0050 article-title: Noninvasive estimation of valve area in patients with aortic stenosis by Doppler ultrasound and two-dimensional echocardiography publication-title: Circulation doi: 10.1161/01.CIR.72.4.810 – volume: 10 start-page: 1117 year: 2008 ident: 10.1016/j.acvd.2014.06.003_bib0130 article-title: Is ventilatory efficiency (VE/VCO(2) slope) associated with right ventricular oxidative metabolism in patients with congestive heart failure? publication-title: Eur J Heart Fail doi: 10.1016/j.ejheart.2008.08.010 – volume: 26 start-page: 1309 year: 2005 ident: 10.1016/j.acvd.2014.06.003_bib0090 article-title: Exercise testing to stratify risk in aortic stenosis publication-title: Eur Heart J doi: 10.1093/eurheartj/ehi250 – volume: 47 start-page: 2521 year: 2006 ident: 10.1016/j.acvd.2014.06.003_bib0020 article-title: Cardiopulmonary exercise testing determination of functional capacity in mitral regurgitation: physiologic and outcome implications publication-title: J Am Coll Cardiol doi: 10.1016/j.jacc.2006.02.043 – volume: 83 start-page: 778 year: 1991 ident: 10.1016/j.acvd.2014.06.003_bib0030 article-title: Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure publication-title: Circulation doi: 10.1161/01.CIR.83.3.778 – volume: 18 start-page: 1440 year: 2005 ident: 10.1016/j.acvd.2014.06.003_bib0060 publication-title: J Am Soc Echocardiogr doi: 10.1016/j.echo.2005.10.005 – volume: 96 start-page: 2221 year: 1997 ident: 10.1016/j.acvd.2014.06.003_bib0135 article-title: Lung function and exercise gas exchange in chronic heart failure publication-title: Circulation doi: 10.1161/01.CIR.96.7.2221 – volume: 33 start-page: 2451 year: 2012 ident: 10.1016/j.acvd.2014.06.003_bib0010 article-title: Guidelines on the management of valvular heart disease (version 2012) publication-title: Eur Heart J doi: 10.1093/eurheartj/ehs109 – volume: 24 start-page: 955 year: 2007 ident: 10.1016/j.acvd.2014.06.003_bib0140 article-title: Left ventricular response to exercise in aortic stenosis: an exercise echocardiographic study publication-title: Echocardiography doi: 10.1111/j.1540-8175.2007.00501.x – volume: 48 start-page: e1 year: 2006 ident: 10.1016/j.acvd.2014.06.003_bib0015 publication-title: J Am Coll Cardiol doi: 10.1016/j.jacc.2006.05.021 – volume: 126 start-page: 2465 year: 2012 ident: 10.1016/j.acvd.2014.06.003_bib0045 article-title: The safety of cardiopulmonary exercise testing in a population with high-risk cardiovascular diseases publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.112.110460 – volume: 106 start-page: 3079 year: 2002 ident: 10.1016/j.acvd.2014.06.003_bib0120 article-title: Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death publication-title: Circulation doi: 10.1161/01.CIR.0000041428.99427.06 |
| SSID | ssj0062776 |
| Score | 2.1378357 |
| Snippet | Risk stratification in asymptomatic patients with severe aortic stenosis (AS) is based on exercise test results. However, differentiating between pathological... Summary Background Risk stratification in asymptomatic patients with severe aortic stenosis (AS) is based on exercise test results. However, differentiating... |
| SourceID | proquest pubmed crossref elsevier |
| SourceType | Aggregation Database Index Database Enrichment Source Publisher |
| StartPage | 519 |
| SubjectTerms | Abnormal exercise test Aged Aortic Valve Stenosis - diagnosis Asymptomatic aortic stenosis Cardiopulmonary exercise testing Cardiovascular Diagnosis, Differential Exercise Test - methods Female Humans Internal Medicine Male Pilot Projects Prognosis Reproducibility of Results Severity of Illness Index Sténose aortique serrée asymptomatique Test d’effort anormal Épreuve d’effort cardiorespiratoire |
| Title | The value of cardiopulmonary exercise testing in individuals with apparently asymptomatic severe aortic stenosis: A pilot study |
| URI | https://www.clinicalkey.com/#!/content/1-s2.0-S1875213614001387 https://www.clinicalkey.es/playcontent/1-s2.0-S1875213614001387 https://dx.doi.org/10.1016/j.acvd.2014.06.003 https://www.ncbi.nlm.nih.gov/pubmed/25240605 https://www.proquest.com/docview/1629953385 |
| Volume | 107 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3di9QwEA_nCeKLeH6ueksE36Ru0yTN1rf18FiVuxc92LeQThPpsbZl2xX2xfvXL5O2C3J6go8tGZJmPunM_IaQNyoG66zCojAVR4LlLMqKBKJ5avIC2NypMK3h7DxdXojPK7k6ICdjLwyWVQ62v7fpwVoPb2bDbc6aspx9ZT7UThj3_iWk27CjHLtKsYlv9WG0xmmiwoA5XBzh6qFxpq_xMvAT0UKZCBie4-Csm87pb8FncEKnD8mDIXqki_6AR-TAVo_IvbMhP_6YXHmuU8TvtrR2FEKtabNde1Ezmx0dxyvRDqE1qu-0rGi5b8hqKf6TpabBmvSqW--oaXc_mq4OoK7UH9JuLDX1Jjx1CDJetu_pgjbluu5owKl9Qi5OP347WUbDiIUIRJp0kcqtj4AAZ_AUXNkCikKJucNkmjLK2SSDmIEEHucWYWeYNVbIXEiv6KkRGX9KDqu6ss8JlQ4gs9xlwKUADqZgmSsgzaUBF1s3IWy8Ww0D_jiOwVjrsdDsUiM_NPJDh2o7PiFv9zRNj75x62o-skyPfaXeEmrvHG6lUn-isu2gzK1muk10rG8I3ITIPeVvMvvPHV-P8qS9MmOGxlS23vqdUh8d-AB8LifkWS9o--9OJAZfsXzxn7u-JPfxqS9EfEUOu83WHvuAqsun5M67X2xK7i4-fVmeT4P-XAMq7yKo |
| linkProvider | Elsevier |
| linkToHtml | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1Lb9QwELZKkYAL4s3yNBI3FDaO7XjDraqoFuj2Qiv1ZjkTGwUtSbTJVtpL-et4nIeECkXimMQjJ54Ze5T55htC3qoYrLMKQWEqjgTLWZQVCUSL1OQFsIVToVvD6iRdnonP5_J8jxyOtTAIqxz2_n5PD7v1cGc-rOa8Kcv5V-ZD7YRxf76EdJu6QW4KbHPgjfr95YTzSBMVOszh6AiHD5UzPcjLwAXShTIRSDzHzllXT6e_RZ_hFDq6R-4O4SM96N_wPtmz1QNyazUkyB-Sn17tFAm8La0dhQA2bbZrb2tms6NjfyXaIbdG9Y2WFS2niqyW4k9ZahoEpVfdekdNu_vRdHVgdaX-Je3GUlNvwlWHLONl-4Ee0KZc1x0NRLWPyNnRx9PDZTT0WIhApEkXqdz6EAiwCU_BlS2gKJRYOMymKaOcTTKIGUjgcW6Rd4ZZY4XMhfSenhqR8cdkv6or-5RQ6QAyy10GXArgYAqWuQLSXBpwsXUzwsa11TAQkGMfjLUekWbfNepDoz50gNvxGXk3yTQ9_ca1o_moMj0WlvqtUPvT4Vop9Scp2w7e3Gqm20TH-orFzYicJH8z2n_O-Ga0J-29GVM0prL11s-U-vDAR-ALOSNPekObvjuRGH3F8tl_zvqa3F6ero718aeTL8_JHXzSoxJfkP1us7UvfXTV5a-C9_wCpOQjKQ |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=The+value+of+cardiopulmonary+exercise+testing+in+individuals+with+apparently+asymptomatic+severe+aortic+stenosis%3A+A+pilot+study&rft.jtitle=Archives+of+cardiovascular+diseases&rft.au=Levy%2C+Franck&rft.au=Fayad%2C+Nader&rft.au=Jeu%2C+Antoine&rft.au=Choquet%2C+Dominique&rft.date=2014-10-01&rft.pub=Elsevier+Masson+SAS&rft.issn=1875-2136&rft.volume=107&rft.issue=10&rft.spage=519&rft.epage=528&rft_id=info:doi/10.1016%2Fj.acvd.2014.06.003&rft.externalDocID=S1875213614001387 |
| thumbnail_m | http://utb.summon.serialssolutions.com/2.0.0/image/custom?url=https%3A%2F%2Fcdn.clinicalkey.com%2Fck-thumbnails%2F18752136%2FS1875213614X00082%2Fcov150h.gif |