0180: Dynamic assessment of valvular heart disease by stress echocardiography

Abstract

Stress echocardiography (SEC) is emerging as an important component of stress testing in patients with valvular heart disease (VHD). The aim of this study is to determinate the indications, proven prognostic values and potential influence on clinical decisions of SEC in left VHD Retrospective study conducted between January 2008 and December 2013. SEC was performed in 12 patients having left VHD. The mean age was 50 years [41; 60]. There were 9 women and 3 men. SEC was realized to study the contractile reserve in 3 patients having severe aortic stenosis with left ventricular systolic dysfunction (LVSD) and in 2 patients of aortic regurgitation with LVSD and to assess the severity of mitral stenosis in 7 very symptomatic patients having moderate mitral stenosis (mean mitral area =1,6 cm 2 ). It was a dobutamine SEC in 9 patients and exercise SEC in 3 patients. We objectified a contractile reserve in the 3 patients with aortic stenosis; subaortic ITV had increased by more than 20%. The mean LV–aortic gradient had increased in 2 patients and decreased in one patient. The 3 patients underwent aortic valve replacement and 2 of them died 2 days after surgery. For the 2 patients presenting aortic regurgitation, we found a contractile reserve in only one patient. The 2 patients were operated with favourable outcome. Concerning patients with mitral stenosis, SEC showed an increase in transmitral mean gradient in 2 patients (from 7 to 12 mmHg and 15 mmHg respectively) with increase of systolic PAP (45 and 46 mmHg to 65 mmHg respectively). Hence, the 2 patients underwent a percutaneous mitral commissurotomy (PMC) which was done with good results. For the other cases, PMC was recused by the lack of significant change in the hemodynamic profile (moderate increase of transmitral mean gradient and systolic PAP). Dynamic evaluation of the severity and hemodynamic effects of VHD can provide the clinician with additional diagnostic and prognostic information that can contribute to subsequent clinical decisions.