“The Emerging Role of Exercise Testing and Stress Echocardiography in Valvular Heart Disease”. Picano, et al. JACC. Vol. 54, No. 24. Dec 2009.
JACC recently published a summary explaining the importance of adding exercise testing and stress echocardiography to the traditional resting echocardiograms used to evaluate valvular function. Although current clinical guidelines do not address this need, clearly more prospective research should be designed to quantify the diagnostic impact that physiological stress can add to resting echo measurements for valvular pathologies and prosthetic valves.
What role does exercise testing play?
Exercise testing and stress echocardiography are both well established testing modalities for evaluating patients with coronary artery disease (CAD) or suspected of having CAD. These tests are both cost-effective and relatively diagnostically accurate. These tests can also be used to identify certain types of induced arrhythmias.
Why add exercise stress to valve assessments?
The most common pathologies that cardiologists look for are aortic stenosis, aortic regurgitation, mital stenosis and mitral regurgitation. Prosthetic valves also require routine checks.
Traditional screening or follow-up for patients with these valvular dysfunctions involves careful symptomatic evaluation and a 3D echo with increasingly accurate color Doppler and visualization technologies.
However, with the exception of the occasional vagal techniques, these are mostly static assessments. Adding a stress (exercise) component to the evaluation induces more clinical diagnostic information like intra-cardiac hemodynamic and ventricular function changes.
Furthermore, the article points out that many of the early onset symptoms that can be induced with physiologic stress allows for a much earlier diagnosis and treatment.
Hemodynamic pressure measurements indicative of severe valve disease such as low-flows or low-gradients often present diagnostic challenges depending upon the degree of left ventricular (LV) dysfunction. In addition, exercise capacity itself is a known predictor of the development of symptoms or LV dysfunction in asymptomatic patients with certain types of valve dysfunction. Prosthetic valves are inherently stenotic.
Therefore, assessing the valve-to-body size impact is an important measurement. Impaired exercise capacity is often the only diagnostic indicator of potential issues.
Stress Testing Equipment
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Cardiac Stress Machine