Abstract
Stress echocardiography is a safe, low‑cost, widely available, radiation‑free versatile imaging modality that is becoming increasingly recognized as a valuable tool in the assessment of coronary heart disease. In recent years, there has also been an increasing use of stress echocardiography in the assessment of nonischemic cardiac disease given its unique ability for simultaneous assessment of both functional performance and exercise‑related noninvasive hemodynamic changes, which can help guide treatment and inform about the prognosis of the patients. Today, in the echocardiography laboratory, we can not only detect wall motion abnormalities resulting from coronary artery stenosis, but also detect alterations to the coronary microvessels, left ventricular systolic and diastolic parameters, heart valves, pulmonary circulation, alveolar‑capillary barrier, and right ventricle. The role of stress echo has been well established in several pathologies, such as aortic stenosis and hypertrophic cardiomyopathy; however, other indications, namely the results of diastolic stress testing and pulmonary hypertension, need additional data and research. This paper presents the current evidence for the role of stress testing in mitral regurgitation, aortic stenosis, hypertrophic cardiomyopathy, heart failure with preserved ejection fraction, and pulmonary hypertension.
Highlights
Stress echocardiography (SE) has an established essential role in evidence ‐based guidelines as a diagnostic tool in daily cardiology practice
The purpose of this paper is to review the pres‐ ent status of SE in conditions other than coronary ar‐ tery disease (CAD), focusing on mitral regurgitation (MR), aortic stenosis (AS), hypertrophic cardiomyopathy (HCM), heart failure with pre‐ served ejection fraction (HFpEF), and pulmonary hypertension (PH)
aortic valve repair (AVR) is indicated in symptomatic patients with true severe AS or in case of symptomatic patients, whose gradi‐ ents did not elevate but the aortic valve area (AVA) remained small‐ er than 1 cm[2] and the presence of flow / contrac‐ tile reserve has been proved.[9]
Summary
Stress echocardiography (SE) has an established essential role in evidence ‐based guidelines as a diagnostic tool in daily cardiology practice It is a valid and useful method for the diagnostic and prognos‐ tic stratification of patients with coronary ar‐ tery disease (CAD)[1] but it shows an emerg‐ ing value in the assessment of cardiac function in other cardiovascular conditions.[2,3,4] Unfor‐ tunately, apart from CAD, the application is still somewhat marginal in the routine cardi‐ ology practice. Stress echocardiography pro‐ vides the opportunity to identify the function of the microvasculature and heart valves, de‐ tect possible pulmonary hypertension (PH), lung congestion, and evaluate the sys‐ tolic and diastolic reaction and mechanics of the left or right ventricle (LV/RV) in response to load. The parameters measured during the stress test combined with exercise capacity, blood pres‐ sure, and heart response will provide a com‐ prehensive, low-cost, noninvasive assessment of cardiovascular pathologies
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