Stress echocardiography in valvular heart disease

Figure 1. Classification of aortic stenosis according to stroke volume and mean transvalvular pressure gradient. AVA, aortic valve area; SVI, stroke volume index.

Figure 2. Evaluation of classical low-flow low-gradient aortic stenosis using dobutamine stress echocardiography. AS, aortic stenosis; AVA, aortic valve area; AVAproj, projected aortic valve area; EF, ejection fraction; FR, flow rate; PG, pressure gradient; SV, stroke volume.

Figure 3. Pseudo severe AS case diagnosed by dobutamine stress echocardiography. A case of classical LFLG AS who underwent DSE. The SVI was significantly increased by low-dose dobutamine stress (20 γ) and the AVA increased by more than 1 cm2. The result confirmed pseudo severe AS in this case. AV, aortic valve; AVA, aortic valve area; DSE, dobutamine stress echocardiography; LFLG, low-flow low-gradient; LVOT, left ventricular outflow tract; MPG, mean pressure gradient; SVI, stroke volume index; VTI, time velocity integral.

Figure 4. Calculation of projected aortic valve area with dobutamine stress echocardiography. AVA, aortic valve area; FR, flow rate; SV, stroke volume.

Figure 5. Exercise stress echocardiography for primary mitral regurgitation. Seventy-two-year-old woman, a case of primary MR due to anterior mitral leaflet prolapse. Dyspnea induced by 20 W exercise on a bicycle ergometer. ESE showed worsening of MR and pulmonary hypertension. EROA, effective regurgitation orifice area; ESE, exercise stress echocardiography; TRPG, tricuspid regurgitation pressure gradient.

Figure 6. Exercise stress echocardiography for secondary mitral regurgitation. Seventy-eight-year-old man, a case of symptomatic secondary MR induced by non-ischemic cardiomyopathy. The MR severity changed from moderate to severe and quantitative parameters (EROA, RV, and SPAP) worsened during exercise. EROA, effective regurgitation orifice area; MR, mitral regurgitation; RV, regurgitation volume; SPAP, systolic pulmonary arterial pressure.

Figure 7. Exercise stress echocardiography for mitral stenosis. Eighty-four-year-old woman, a case of calcified severe MS confirmed by ESE. During exercise, MMPG increased from 5.7 mmHg to 24.9 mmHg and significant Ex-PH was observed. ESE, exercise stress echocardiography; MMPG, mean mitral pressure gradient; MS. mitral; stenosis; SPAP, systolic pulmonary arterial pressure.

Figure 8. Stress echocardiography for prosthetic valve. Eighty-five-year-old man, a case of PPM after TAVI. Exercise stress induced increase of transprosthetic MPG, SPAP and worsening of diastolic dysfunction. MPG, mean pressure gradient; PPM, patient prosthesis mismatch; SPAP, systolic pulmonary arterial pressure; TAVI, transcatheter aortic valve implantation.