Key result
Stress echocardiography provides valuable diagnostic and prognostic information in valvular heart disease, particularly for evaluating asymptomatic severe or symptomatic non-severe mitral regurgitation and suspected low-flow, low-gradient severe aortic stenosis.
Why the study?
Stress echocardiography is recommended in valvular heart disease when resting echocardiography findings and symptoms mismatch, prompting a review of current methodology and supporting evidence.
Stress echocardiography provides comprehensive assessment in valvular heart disease when resting echo findings and symptoms are discordant, though large-scale prospective studies are needed to support stress echo-driven treatment strategies.
May guide management in discrepant valvular cases; leaves open need for large-scale prospective trials to validate protocols.
PURPOSE OF REVIEW: Stress echocardiography is recommended in valvular heart disease when there is a mismatch between resting transthoracic echocardiography findings and symptoms during activities of daily living. We describe the current methodology and the evidence supporting these applications. RECENT FINDINGS: The comprehensive stress echo assessment includes valve function (gradients and regurgitation), left ventricular global systolic and diastolic function, left atrial volume, pulmonary congestion, pulmonary arterial pressure, and right ventricular function, integrated with blood pressure response with cuff sphygmomanometer, chronotropic reserve with heart rate, and symptoms. Recent guidelines recommend the evaluation of asymptomatic severe or symptomatic non-severe mitral regurgitation or stenosis with exercise stress and suspected low-flow, low-gradient severe aortic stenosis with reduced ejection fraction with low dose (up to 20 mcg, without atropine) dobutamine stress. Prospective, large-scale studies based on a comprehensive protocol (ABCDE +) capturing the multiplicity of clinical phenotypes are needed to support stress echo-driven treatment strategies.
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Citro et al. (2022) conducted a review in Valvular Heart Disease. Stress echocardiography was evaluated. Stress echocardiography provides valuable diagnostic and prognostic information in valvular heart disease, particularly for evaluating asymptomatic severe or symptomatic non-severe mitral regurgitation and suspected low-flow, low-gradient severe aortic stenosis.
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