title: Exercise Testing and Stress Imaging in Mitral Valve Disease.
abstract: Mitral valve disease represented by mitral stenosis and mitral regurgitation is the second most frequent valvulopathy. Mitral stenosis leads to an increased left atrial pressure whereas mitral regurgitation leads to an increased left atrial pressure associated with a volume overload. Secondary to an upstream transmission of this overpressure, both mitral stenosis and regurgitation lead to pulmonary hypertension and right heart failure. In addition, mitral regurgitation also leads to left ventricular dilatation and dysfunction with left heart failure. Depending on the anatomy of the valvular and subvalvular apparatus, valve repair (percutaneous mitral commissurotomy for mitral stenosis and valvuloplasty for mitral regurgitation) might be possible. If the anatomy is not favorable, valve replacement by mechanical or biological prosthesis is indicated. Most of the intervention indications are based on clinical symptoms and resting transthoracic echocardiography. Outcomes of patients operated based upon resting echo abnormalities might however not be optimal. Therefore early intervention might be beneficial based upon abnormal exercise testing, which has been demonstrated to more sensitive to identify high-risk patients. In this last decade, especially exercise echocardiography has been found to be a crucial tool in the management of patients with mitral valve disease.
authors.affiliation: Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, Centre Hospitalier Universitaire de Nancy, Vandœuvre-lès-Nancy, France.|IADI, INSERM U947, University of Lorraine, Nancy, France.|Centre Hospitalier Lunéville, Service de Cardiologie, Lunéville, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Voilliot
authors.affiliation: GIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart Tilman, University of Liège Hospital, Liège, Belgium. plancellotti@chu.ulg.ac.be.|Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy. plancellotti@chu.ulg.ac.be.|Department of Cardiology, University of Liège Hospital, CHU du Sart Tilman, Avenue de l'hôpital, 1, 4000, Liège, Belgium. plancellotti@chu.ulg.ac.be.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
keywords: Echocardiography; Exercise; Mitral valve disease; Valvular heart disease