Key result
Upright exercise stress echocardiography provides a more physiological assessment of subaortic and valvular gradients compared to supine testing, warranting a standardized protocol.
Highlights the need for standardized stress echocardiography protocols, particularly upright exercise testing, to accurately assess load-dependent changes in subaortic and valvular gradients.
(Semi) supine exercise testing has an established role in the evaluation of patients with valvular heart disease and can help clinical decision making. Stress echocardiography has the advantages of its wide availability, low cost, and versatility for the assessment of disease severity. However, exercise-induced changes in valve hemodynamics, left ventricular outflow obstruction and pulmonary artery pressure depended on load variation. Changing position from supine to upright rapidly decreases load conditions for the ventricles. Therefore several cardiac centers have proposed exercise stress echocardiography in the upright position with gradient monitoring sometimes also in post-exercise recovery. Doppler measurement of subaortic gradient has been a very helpful and informative examination in several heart diseases (especially in hypertrophic cardiomyopathy, valve heart diseases, prosthesis dysfunction).
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Dimitrow et al. (2014) conducted a review in Hypertrophic cardiomyopathy and valvular heart disease. Upright exercise stress echocardiography vs. Supine or semi-supine exercise stress echocardiography was evaluated. Upright exercise stress echocardiography provides a more physiological assessment of subaortic and valvular gradients compared to supine testing, warranting a standardized protocol.
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