title: Exercise stress echocardiography in patients with valvular heart disease.
abstract: Stress echocardiography is recommended for the assessment of asymptomatic patients with severe valvular heart disease (VHD) when there is discrepancy between symptoms and resting markers of severity. The aim of this study is to determine the prognostic value of exercise stress echocardiography in patients with common valve lesions. One hundred and fifteen patients with VHD (aortic stenosis (n=28); aortic regurgitation (n=35); mitral regurgitation, (n=26); mitral stenosis (n=26)), and age- and sex-matched controls (n=39) with normal ejection fraction underwent exercise stress echocardiography. The primary endpoint was a composite of death or hospitalization for heart failure. Asymptomatic VHD patients had lower exercise capacity than controls and 37% of patients achieved <85% of their predicted metabolic equivalents (METS). There were three deaths and four hospital admissions, and 24 patients underwent surgery during follow-up. An abnormal stress echocardiogram (METS <5, blood pressure rise <20 mmHg, or pulmonary artery pressure post exercise >60 mmHg) was associated with an increased risk of death or hospital admission (14% vs 1%, P<0.0001). The assessment of contractile reserve did not offer additional predictive value. In conclusion, an abnormal stress echocardiogram is associated with death and hospitalization with heart failure at 2 years. Stress echocardiography should be considered as part of the routine follow-up of all asymptomatic patients with VHD.
authors.affiliation: Department of Cardiology, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK; Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
authors.forename: Vishal
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK.
authors.forename: David E
authors.initials: DE
authors.lastname: Newby
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital , Auckland , New Zealand.
authors.forename: Ralph A H
authors.initials: RA
authors.lastname: Stewart
authors.affiliation: Department of Cardiology, Middlemore Hospital , Auckland , New Zealand.
authors.forename: Mildred
authors.initials: M
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Middlemore Hospital , Auckland , New Zealand.
authors.forename: Ruvin
authors.initials: R
authors.lastname: Gabriel
authors.affiliation: Department of Cardiology, Middlemore Hospital , Auckland , New Zealand.
authors.forename: Niels
authors.initials: N
authors.lastname: Van Pelt
authors.affiliation: Department of Cardiology, Middlemore Hospital , Auckland , New Zealand.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kerr
keywords: echocardiography; exercise testing; stress echocardiography; valvular heart disease