- Mazen Awais: Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, Michigan, USA.
Aortic valve replacement is the accepted therapy for patients with severe symptomatic aortic stenosis (AS). However, the timing of surgery in asymptomatic patients is less well defined, as some -- but not all -- asymptomatic patients are at increased risk. Exercise stress testing is an attractive means to assess risk in such patients, as it is readily available, standardized, physiological, and presents a controlled environment in which to assess whether patients truly are asymptomatic. This review summarizes existing literature and current guideline recommendations addressing exercise testing in asymptomatic patients with AS, and provides a recommendation for its use in a subset of patients.