Stress Echocardiography in Valvular Heart Disease

Abstract

In addition to the noninvasive diagnosis of coronary artery disease, stress echocardiography has been used increasingly in the evaluation of valvular heart disease. As exertional symptoms are encountered commonly in patients with valvular heart disease, evaluation of valvular function during exercise may give important diagnostic and prognostic information. Stress echocardiography allows evaluation of valvular function during provocation. It can also provide an objective assessment of overall fitness and functional capacity as well as an assessment of left and right ventricular response to stress, which may give an indication of myocardial reserve. In patients with mitral and aortic regurgitation, assessment of left ventricular ejection fraction, end-systolic volume, and wall stress at exercise have been shown to be more predictive than their respective resting indices in predicting surgical outcome, morbid events, and symptomatic progression. In patients with mitral stenosis, stress echocardiography has been used to assess changes in transvalvular gradients with exercise and has been demonstrated to be an aid in deciding for or against surgical referral. Furthermore, pulmonary systolic pressure during exercise can also be evaluated by stress echocardiography and provides more diagnostic and prognostic information than the same measurement at rest. In patients with aortic stenosis with impaired ventricular function, dobutamine echocardiography has been used to evaluate the hemodynamic significance of the aortic stenosis. Furthermore, stress echocardiography has been used to assess response to medical or interventional therapies in patients with valvular heart disease. In this article, we will outline the utilities of exercise echocardiography in the evaluation of different forms of valvular heart diseases.