title: Exercise testing and stress imaging in valvular heart disease.
abstract: The role of exercise testing and stress imaging in the management of patients with valvular heart disease (VHD) is reviewed in this article. The American College of Cardiology/American Heart Association and the European Society of Cardiology/European Association of Cardiothoracic Surgery have recently put emphasis on the role of exercise testing to clarify symptom status and the use of stress imaging to assess the dynamic component of valvular abnormalities and unmask subclinical myocardial dysfunction that could be missed at rest. Recent studies have demonstrated the incremental prognostic value of exercise echocardiography for asymptomatic patients with severe aortic stenosis, moderate-severe mitral stenosis, and severe primary mitral regurgitation. In patients with low-flow, low-gradient aortic stenosis, dobutamine stress echocardiography is recommended to differentiate true severe from pseudosevere aortic stenosis. Data on the prognostic value of stress echocardiography in aortic regurgitation and functional mitral regurgitation are less robust. Data are sparse on the use of stress imaging in right-sided VHD, however recent studies using stress cardiovascular magnetic resonance imaging offer some prognostic information. Although the strongest recommendations for surgical treatment continue to be based on symptom status and resting left ventricular repercussions, stress imaging can be useful to optimize risk stratification and timing of surgery in VHD. Randomized clinical trials are required to confirm that clinical decision-making based on stress imaging can lead to improved outcomes.
authors.affiliation: Research Centre and Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada; Heart Valve Clinic, University of Liège, Department of Cardiology, Sart Tilman University Hospital, Liège, Belgium.
authors.forename: Christine
authors.initials: C
authors.lastname: Henri
authors.affiliation: Heart Valve Clinic, University of Liège, Department of Cardiology, Sart Tilman University Hospital, Liège, Belgium.
authors.forename: Luc A
authors.initials: LA
authors.lastname: Piérard
authors.affiliation: Heart Valve Clinic, University of Liège, Department of Cardiology, Sart Tilman University Hospital, Liège, Belgium.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
authors.affiliation: Research Centre and Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: François-Pierre
authors.initials: FP
authors.lastname: Mongeon
authors.affiliation: Québec Heart and Lung Institute, Québec, Québec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.affiliation: Research Centre and Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada. Electronic address: arsene.basmadjian@icm-mhi.org.
authors.forename: Arsène J
authors.initials: AJ
authors.lastname: Basmadjian
mesh_terms: D001022:Aortic Valve Insufficiency / Q000175:diagnosis; D001024:Aortic Valve Stenosis / Q000175:diagnosis; D001794:Blood Pressure; D003657:Decision Making; D004280:Dobutamine; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005080:Exercise Test / Q000379:methods; D006349:Heart Valve Diseases / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000175:diagnosis; D008946:Mitral Valve Stenosis / Q000175:diagnosis; D011379:Prognosis; D011651:Pulmonary Artery / Q000502:physiology; D016277:Ventricular Function, Left
chemical_list: D004280:Dobutamine