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

Abstract

Stress echocardiography is a widely available, safe, low-cost, versatile imaging modality which is becoming increasingly recognized as a valuable tool in the assessment of patients with native and prosthetic left-sided valvular heart disease. It provides a quantitative assessment to help guide clinical decision-making when discordance exists between symptoms and severity of valve disease. Exercise (treadmill or bicycle) remains the preferred stress modality, but pharmacological augmentation with dobutamine can be used if needed. Low-dose dobutamine stress echocardiography is specifically valuable in patients with low-flow, low-gradient aortic stenosis when attempting to differentiate true severe aortic stenosis from pseudo-severe aortic stenosis. Stress echocardiography not only identifies high-risk features that indicate need for earlier surgery, it also provides useful information for the peri- and postoperative period, including long-term outcome, risk stratification to guide monitoring frequency, and offers guidance for eligibility in competitive sports participation. As research continues to expand the utility of stress echocardiography in the management of patients with valvular heart disease, future research should focus on the recognition of newer parameters identifying high-risk features including subsequent validation in a large population.

Prospective multicenter Polish Stress Echocardiography Registry (PolStress-Echopro) – the role in clinical practice

“…12 New guidelines for the treatment of VHDs which appeared recently should influence the wider management of SE in the assessment of VHD, thus improving further therapeutic decisions and patients' prognosis. 13,14 The guidelines contain some minor modifications related to the outcome of SE performed in asymptomatic AS and in primary asymptomatic MR. 13 The class IIb C indication for valvular surgery in asymptomatic AS when the mean gradient increased by >20 mm Hg in the SE exercise test, was excluded. Similarly, in patients with primary asymptomatic MR, exertional increase in systolic pressure in the pulmonary artery >60 mm Hg is no longer considered an indication for surgery.…”

Assessment of Complex Multi-Valve Disease and Prosthetic Valves

“…Particularly in the case of combined non-severe lesions, patients may be asymptomatic at rest but exercise may worsen the haemodynamic consequences of dominant lesions and produce symptoms. Exercise haemodynamic parameters, such as an increase in transvalvular gradients, elevations in pulmonary artery pressure, and the absence of LV contractile reserve might be relevant in deciding the appropriateness and timing of intervention [18,30]. The assessment of multiple valves during semi-supine bicycle exercise is feasible, and mixed stenotic and regurgitant lesions can be evaluated with a combination of colour flow and Doppler imaging [18].…”

Ischemic mitral regurgitation: modern evidence based echocardiography diagnosis, quantification and risks stratification review

“…Gentry та співавт. встановили певні критерії високого ризику у зв'язку із знахідками під час стрес-ЕхоКГ з ДФН, ґрунтуючись на класифікації ступеня тяжкості МР (помірна або тяжка, первинна або вторинна) (таблиця 2) [13].…”