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Review
. 2023 Dec 14:10:1233924.
doi: 10.3389/fcvm.2023.1233924. eCollection 2023.

Stress echocardiography in valvular heart disease

Kensuke Hirasawa  1 , Masaki Izumo  2 , Yoshihiro J Akashi  2
Affiliations
Review

Stress echocardiography in valvular heart disease

Kensuke Hirasawa et al. Front Cardiovasc Med. .

Abstract

Valvular heart disease (VHD) has been a significant health problem, particularly in developed countries, in relation to the aging population. Recent developments in the management of VHD require a more accurate assessment of disease severity to determine the need for transcatheter interventions or open heart surgery. Stress echocardiography is a crucial imaging modality for identifying the underlying pathology of VHD. Optimal administration of exercise or intravenous drugs may reveal hemodynamic abnormalities under stress without posing an invasive risk. Therefore, the implementation of stress echocardiography is recommended for determining interventional indications and risk stratification in mitral regurgitation and aortic stenosis. In addition, recent evidence has accumulated regarding the usefulness of stress echocardiography in various conditions including mitral stenosis, aortic regurgitation, and post-interventional VHD. Here, we summarize the current evidence and future perspectives on stress echocardiography in VHD.

Keywords: aortic stenosis; exercise; mitral regurgitation; stress echocardiography; valvular heart disease.

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Conflict of interest statement

MI is a screening proctor of Edwards Lifesciences and a clinical proctor of Abbott Medical Japan. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
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
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
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
Figure 4
Calculation of projected aortic valve area with dobutamine stress echocardiography. AVA, aortic valve area; FR, flow rate; SV, stroke volume.
Figure 5
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
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
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
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.
See this image and copyright information in PMC

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