title: The Role of Stress Echocardiography in Valvular Heart Disease: A Current Appraisal.
abstract: Stress echocardiography is a widely available, safe, low-cost, versatile imaging modality which is becoming increasingly recognized as a valuable tool in the assessment of patients with native and prosthetic left-sided valvular heart disease. It provides a quantitative assessment to help guide clinical decision-making when discordance exists between symptoms and severity of valve disease. Exercise (treadmill or bicycle) remains the preferred stress modality, but pharmacological augmentation with dobutamine can be used if needed. Low-dose dobutamine stress echocardiography is specifically valuable in patients with low-flow, low-gradient aortic stenosis when attempting to differentiate true severe aortic stenosis from pseudo-severe aortic stenosis. Stress echocardiography not only identifies high-risk features that indicate need for earlier surgery, it also provides useful information for the peri- and postoperative period, including long-term outcome, risk stratification to guide monitoring frequency, and offers guidance for eligibility in competitive sports participation. As research continues to expand the utility of stress echocardiography in the management of patients with valvular heart disease, future research should focus on the recognition of newer parameters identifying high-risk features including subsequent validation in a large population.
authors.affiliation: Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Gentry Iii
authors.forename: Dermot
authors.initials: D
authors.lastname: Phelan
authors.forename: Milind Y
authors.initials: MY
authors.lastname: Desai
authors.forename: Brian P
authors.initials: BP
authors.lastname: Griffin
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004280:Dobutamine / Q000008:administration & dosage; D025401:Echocardiography, Stress; D005080:Exercise Test / Q000379:methods; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012720:Severity of Illness Index; D012955:Societies, Medical; D013318:Stroke Volume; D016277:Ventricular Function, Left
chemical_list: D004280:Dobutamine
keywords: Dobutamine; Exercise; Guidelines; Sports eligibility; Stress echocardiography; Valvular heart disease