Valve Stress Echocardiography

Garbi, Madalina; Chambers, John; Vannan, Mani A.; Lancellotti, Patrizio

doi:10.1016/j.jcmg.2015.02.010

Cited by 59 publications

(29 citation statements)

References 51 publications

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“…The severity of concomitant mitral regurgitation improves after the procedure in 2 out of 3 patients, but baseline moderate-severe mitral regurgitation and significant residual mitral regurgitation are associated with an increase in mortality after Transcatheter Aortic Valve Implantation and represent an important group to target with medical or transcatheter therapies in the future [40]. Stress echo plays a pivotal role in valvular heart disease [41], but its role after either Transcatheter Aortic Valve Implantation or surgical replacement is still unsettled, although it has potential to identify the presence and severity of mitral regurgitation and aortic stenosis after intervention, so as to refine the prognostic strategy and better tailor treatment.…”

Section: Methodsmentioning

confidence: 99%

Stress echo 2020: the international stress echo study in ischemic and non-ischemic heart disease

Picaño

Ciampi

Citro

et al. 2017

Cardiovasc Ultrasound

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BackgroundStress echocardiography (SE) has an established role in evidence-based guidelines, but recently its breadth and variety of applications have extended well beyond coronary artery disease (CAD). We lack a prospective research study of SE applications, in and beyond CAD, also considering a variety of signs in addition to regional wall motion abnormalities.MethodsIn a prospective, multicenter, international, observational study design, > 100 certified high-volume SE labs (initially from Italy, Brazil, Hungary, and Serbia) will be networked with an organized system of clinical, laboratory and imaging data collection at the time of physical or pharmacological SE, with structured follow-up information. The study is endorsed by the Italian Society of Cardiovascular Echography and organized in 10 subprojects focusing on: contractile reserve for prediction of cardiac resynchronization or medical therapy response; stress B-lines in heart failure; hypertrophic cardiomyopathy; heart failure with preserved ejection fraction; mitral regurgitation after either transcatheter or surgical aortic valve replacement; outdoor SE in extreme physiology; right ventricular contractile reserve in repaired Tetralogy of Fallot; suspected or initial pulmonary arterial hypertension; coronary flow velocity, left ventricular elastance reserve and B-lines in known or suspected CAD; identification of subclinical familial disease in genotype-positive, phenotype- negative healthy relatives of inherited disease (such as hypertrophic cardiomyopathy).ResultsWe expect to recruit about 10,000 patients over a 5-year period (2016-2020), with sample sizes ranging from 5,000 for coronary flow velocity/ left ventricular elastance/ B-lines in CAD to around 250 for hypertrophic cardiomyopathy or repaired Tetralogy of Fallot. This data-base will allow to investigate technical questions such as feasibility and reproducibility of various SE parameters and to assess their prognostic value in different clinical scenarios.ConclusionsThe study will create the cultural, informatic and scientific infrastructure connecting high-volume, accredited SE labs, sharing common criteria of indication, execution, reporting and image storage of SE to obtain original safety, feasibility, and outcome data in evidence-poor diagnostic fields, also outside the established core application of SE in CAD based on regional wall motion abnormalities. The study will standardize procedures, validate emerging signs, and integrate the new information with established knowledge, helping to build a next-generation SE lab without inner walls.

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Section: Methodsmentioning

confidence: 99%

Stress echo 2020: the international stress echo study in ischemic and non-ischemic heart disease

Picaño

Ciampi

Citro

et al. 2017

Cardiovasc Ultrasound

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“…Protocols, guide for referral, procedure, and reporting for valve stress echocardiography have been recently discussed. 26 In asymptomatic severe AS (C1 stage), exercise is the optimal stressor and is a class IIa indication in the ACC/ AHA guidelines, whereas it is strongly advocated in the European Society of Cardiology recommendations. 2,27 Exercise testing or exercise stress echocardiography using a modified Bruce protocol is useful to unmask symptoms in patients with severe AS who claim to be asymptomatic (Table 2).…”

Section: Exercise Testing and Stress Echocardiographymentioning

confidence: 99%

Multimodality Imaging Strategies for the Assessment of Aortic Stenosis

Dulgheru

Pîbarot

Sengupta

et al. 2016

Circ: Cardiovascular Imaging

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Abstract-Aortic stenosis is the most frequent valvular heart disease. In aortic stenosis, therapeutic decision essentially depends on symptomatic status, stenosis severity, and status of left ventricular systolic function. Surgical aortic valve replacement or transcatheter aortic valve implantation is the sole effective therapy in symptomatic patients with severe aortic stenosis, whereas the management of asymptomatic patients remains controversial and is mainly based on individual risk stratification. Imaging is fundamental for the initial diagnostic work-up, follow-up, and selection of the optimal timing and type of intervention. The present review provides specific recommendations for utilization of multimodality imaging to optimize risk stratification and therapeutic decision-making processes in aortic stenosis. (Circ Cardiovasc Imaging. 2016;9:e004352.

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“…DSE may help to grade AS severity also in paradoxical LF/LG AS. In these cases, DSE should be used with caution and could be potentially contraindicated if the LV has severe hypertrophy, given the high likelihood of dobutamineinduced LVOT obstruction and drop in blood pressure during the test [11].…”

Section: Stress Echocardiographymentioning

confidence: 99%

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)

Dimitrova¹,

Kossaify²

2016

SJAMS

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Aortic valve stenosis (AS) is a relatively frequent pathology in the elderly and management is mainly dependent on the degree of stenosis and the potential presence of comorbidities. Transthoracic echocardiography (TTE) is the basic initial test for aortic valve imaging, yielding valuable measurements of aortic valve area, peak velocity, mean and peak gradients and dimensionless velocity index. TTE allows to classify the type of AS, as high gradient/normal flow (HG/NF), low gradient/normal flow (LG/NF), high gradient/low flow (HG/LF) and low gradient/low flow (LG/LF); the latter is also subdivided into regular or paradoxical LG/LF according to the value of the ejection fraction (EF). Transoesophageal echocardiography (TOE) has an added value compared to TTE for detailed anatomical visualization of the aortic valve and adjacent structures, also it is particularly useful as a perprocedural test during transcatheter aortic valve implantation (TAVI). Moreover, stress echocardiography (SE) is useful in cases where accurate assessment of the degree of stenosis is challenging, especially in LF/LG AS. In summary, appropriate assessment of AS is essential in order to guide decision making and echocardiography is the gold standard test for this purpose.

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Valve Stress Echocardiography

Cited by 59 publications

References 51 publications

Stress echo 2020: the international stress echo study in ischemic and non-ischemic heart disease

Stress echo 2020: the international stress echo study in ischemic and non-ischemic heart disease

Multimodality Imaging Strategies for the Assessment of Aortic Stenosis

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)

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