Stress echo for evaluation of valvular heart disease

Abstract

Resting echocardiography is the most important tool for diagnosing valvular heart disease. However, treatment planning in valvular heart diseases may require additional information in some patients, particularly asymptomatic patients with severe valve disease or symptomatic patients with moderate disease. Stress echocardiography provides invaluable information in these situations and aids decision making. Stress echocardiography is performed using either physical stress or dobutamine stress and various valve parameters are monitored during the stress. Further, the ventricular performance, which is an important determinant of outcome in valve disease is also closely monitored during stress which helps immensely in planning the intervention. Lastly, possibility of associated coronary artery disease can also be evaluated, especially in the elderly. This article discusses the role of stress evaluation in assessment of valve disease in the commonly encountered clinical situations.

Echocardiogram for Aortic Valve Stenosis, the Complex Interplay between Flow and Gradient and Insight into Stress Echocardiography and Transoesophageal Echo for Transcatheter Aortic Valve Implantation (TAVI)

“…At every stage of the test, AV/VTI, LVOT/VTI, transvalvular mean and peak gradients, stroke volume and LVEF are acquired and stored. The LVOT diameter is measured at baseline at mid-systole and the same diameter is used to calculate by continuity-equation the valve area at each stage; whether LVOT diameter should be remeasured during the test and AVA recalculated accordingly is debated, given that LVOT diameter is a dynamic parameter and it may vary (increase or decrease) according to changes in LV end diastolic volume and pressure [8,9].…”

“…Accordingly, the test may be associated with side effects related either to the drug (Dobutamine), and/or to the underlying cardiac conditions (i.e stress arrhythmia, angina). In this respect, it is essential to conform with international standards regarding the indications and precautions of the test appropriate use criteria [9]. Moreover, if there is no significant contractile reserve (i.e.…”

“…Moreover, if there is no significant contractile reserve (i.e. stroke volume and LVEF do not appreciably increase with dobutamine), distinction between true-severe and pseudo-severe AS cannot be made [9]. Aortic valve replacement should be considered in symptomatic patients with LF/LG with reduced EF, and with evidence of contractile (or flow) reserve [9,10].…”

“…stroke volume and LVEF do not appreciably increase with dobutamine), distinction between true-severe and pseudo-severe AS cannot be made [9]. Aortic valve replacement should be considered in symptomatic patients with LF/LG with reduced EF, and with evidence of contractile (or flow) reserve [9,10]. TRANSOESOPHAGEAL ECHOCARDIOGRAPHY TOE provides definitely a better anatomical view of the AV and related structures, also it allows a more precise measurement of the LVOT and annulus diameter, these parameters are important when there is a management perspective for TAVI.…”

The Role of Stress Echocardiography in Valvular Heart Disease: A Current Appraisal

“…Stress echocardiography can be performed before and after exercise (treadmill/bicycle), or, in specific situations such as low-flow, low-gradient (LFLG) aortic stenosis (AS), pharmacological stress using low-dose dobutamine (up to 20 μg/kg/min) to augment the cardiac output and determine the effect of this on the aortic valve (AV) area (AVA) and transvalvular pressure gradients (TPGs) [9]. In any stress test for the assessment of valve disease, comprehensive hemodynamic data and images are acquired at rest and subsequently at peak exercise.…”