This prespecified registry of the EARLY TAVR trial evaluated the safety of treadmill stress testing (TST), 2-year clinical outcomes, and rates of aortic valve replacement (AVR) in 105 apparently asymptomatic patients with severe AS who had a positive TST result, across 75 US sites (July 2017–December 2021).
TST was safe (no deaths, syncope, or cardioversions). At 2 years, all-cause mortality was 5.7% (Kaplan-Meier). AVR rates were 79.9% at 1 year and 85.9% at 2 years — meaning ~20% of patients with a positive TST (and a guideline indication for prompt treatment) remained untreated at 1 year. Predictors of a positive TST included higher peak velocity, lower ejection fraction, prior CABG, and prior stroke.
Only 105 of 146 eligible patients with a positive TST consented to enroll, introducing potential selection bias. The registry is observational with no randomized comparator for outcomes in TST-positive patients. Reasons for delayed or absent AVR despite a positive TST were not described.
TST is safe in asymptomatic severe AS and unmasked an AVR indication in ~15% of screened patients — reinforcing its routine use in this population. Clinicians should note that a positive TST warrants prompt referral for AVR, as 1 in 5 such patients in this registry still had not received treatment at 1 year.
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