title: Valvular flow abnormalities are often identified by a resting focused Doppler examination performed at the time of stress echocardiography.
abstract: BACKGROUND
  Patients are usually referred for stress echocardiography to assess whether there is inducible myocardial ischemia. At some centers, a focused Doppler examination is also performed. We sought to determine the clinical value of this additional study by examining how often valvular flow abnormalities were identified that might affect clinical care.
  
  
  METHODS
  We reviewed 1272 consecutive stress echocardiogram reports from a 1-year period, including 1223 tests that contained focused Doppler data. Important Doppler findings were defined as at least moderate mitral regurgitation, at least mild aortic regurgitation, any aortic or mitral valve stenosis, or any resting left ventricular outflow tract gradient.
  
  
  RESULTS
  Overall, focused Doppler identified an important Doppler abnormality in 214 patients (17%). At least moderate mitral regurgitation was identified in 67 patients (5%) and at least mild aortic regurgitation was identified in 163 patients (13%). In addition, aortic stenosis (n = 14; 1%), mitral stenosis (n = 5; 0.4%), and resting outflow tract gradient (n = 2; 0.2%) were noted. A prior echocardiogram had been performed at our institution in 317 patients (26%). For this subset, a new important Doppler finding, a two-step change in regurgitant grade, or a one-step change in stenosis severity was noted in 28 patients (9%). Among patients who had a previous study, the prevalence of new findings was the same (9%) in those who had been studied within the previous year as in those whose previous study had been performed more than 2 years before.
  
  
  CONCLUSIONS
  Focused Doppler documents valvular flow abnormalities in 17% of patients referred for stress echocardiography, thereby enhancing the potential overall value of the test. The frequency of new findings was independent of the time interval from the previous Doppler study. These data should be considered when clinicians choose a stress imaging modality.
authors.affiliation: Harvard-Thorndike Laboratory of the Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Gaur
authors.forename: Susan B
authors.initials: SB
authors.lastname: Yeon
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Lewis
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Manning
mesh_terms: D000368:Aged; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging*; D018618:Echocardiography, Doppler, Color; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging*; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*