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STATE-OF-THE-ART PAPER

The Emerging Role of Exercise Testing and Stress Echocardiography in Valvular Heart Disease

Eugenio Picano, MD, PhD^_*, Philippe Pibarot, MD, PhD, Patrizio Lancellotti, MD, PhD, Jean Luc Monin, MD, PhD and Robert O. Bonow, MD^||,_*

^_* CNR, Institute of Clinical Physiology, Fondazione G. Monasterio, Pisa, Italy
Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
Department of Cardiology, University Hospital of Sart Tilman, Liège, Belgium
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
^|| Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois

Manuscript received February 5, 2008; revised manuscript received July 8, 2009, accepted July 28, 2009.

^_* Reprint requests and correspondence: Dr. Robert O. Bonow, Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair, Suite 600, Chicago, Illinois 60611 (Email: r-bonow{at}northwestern.edu).

Exercise testing has an established role in the evaluation of patients with valvular heart disease and can aid clinical decision making. Because symptoms may develop slowly and indolently in chronic valve diseases and are often not recognized by patients and their physicians, the symptomatic, blood pressure, and electrocardiographic responses to exercise can help identify patients who would benefit from early valve repair or replacement. In addition, stress echocardiography has emerged as an important component of stress testing in patients with valvular heart disease, with relevant established and potential applications. Stress echocardiography has the advantages of its wide availability, low cost, and versatility for the assessment of disease severity. The versatile applications of stress echocardiography can be tailored to the individual patient with aortic or mitral valve disease, both before and after valve replacement or repair. Hence, exercise-induced changes in valve hemodynamics, ventricular function, and pulmonary artery pressure, together with exercise capacity and symptomatic responses to exercise, provide the clinician with diagnostic and prognostic information that can contribute to subsequent clinical decisions. Nevertheless, there is a lack of convincing evidence that the results of stress echocardiography lead to clinical decisions that result in better outcomes, and therefore large-scale prospective randomized studies focusing on patient outcomes are needed in the future.

Key Words: exercise testing • valve • echocardiography • stress echocardiography

Abbreviations and Acronyms   ACC/AHA = American College of Cardiology/American Heart Association   AR = aortic regurgitation   AS = aortic stenosis   AVA = aortic valve area   AVR = aortic valve replacement   CAD = coronary artery disease   ESC = European Society of Cardiology   LV = left ventricular   MR = mitral regurgitation   MS = mitral stenosis   MVA = mitral valve area   PPM = valve prosthesis–patient mismatch

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J. Am. Coll. Cardiol. 2009 54: A33. [Full Text] [PDF]