COR LOE Recommendations In asymptomatic patients with severe AS (Stage C1), exercise testing is reasonable to assess physiological changes with exercise and to confirm the absence of 3: Harm B-NR In symptomatic patients with severe AS (Stage D1, aortic velocity 4.0 m/s or mean pressure gradient 40 mmHg), exercise testing should not be performed because of the risk of severe Synopsis In a subset of asymptomatic patients with severe AS, exercise testing can provide additional diagnostic and prognostic information, but it should not be performed in symptomatic patients with severe AS. Recommendation-Specific Supportive Text 1. When performed under the direct supervision of an experienced clinician, with close monitoring of blood pressure and ECG, exercise testing in asymp- tomatic patients is relatively safe and may provide information that is not evident during the initial clinical evaluation, particularly when the patient s functional capacity is unclear. Patients with symp- toms provoked by exercise testing should be con- sidered symptomatic, even if the clinical history is equivocal. Although it can be challenging to sep- arate normal exercise limitations from abnormal symptoms that are attributable to AS, particularly in elderly sedentary patients, exercise-induced angina, excessive dyspnea early in exercise, dizzi- ness, and syncope are consistent with symptoms of AS. Exercise testing can also identify a limited exercise capacity or an abnormal blood pressure response. Recording aortic valve hemodynam- ics with exercise is of limited value and does not show additive value for predicting clinical out- come when baseline measures of hemodynamic severity and functional status are considered. In addition, recording hemodynamics with exercise is challenging, and simpler parameters are ade- quate in most patients.2 4,6 11 2. As reported in several prospective and retrospec- tive studies, the risk of exercise testing is low in asymptomatic patients with AS. 