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Exercise testing and stress imaging in valvular heart disease
- Source :
- The Canadian journal of cardiology. 30(9)
- Publication Year :
- 2013
-
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.
- Subjects :
- medicine.medical_specialty
Aortic Valve Insufficiency
Decision Making
Heart Valve Diseases
Blood Pressure
Pulmonary Artery
Asymptomatic
Ventricular Function, Left
Electrocardiography
Internal medicine
Dobutamine
medicine
Stress Echocardiography
Humans
Mitral Valve Stenosis
Mitral regurgitation
medicine.diagnostic_test
business.industry
valvular heart disease
Mitral Valve Insufficiency
Magnetic resonance imaging
Aortic Valve Stenosis
medicine.disease
Prognosis
Stenosis
Cardiothoracic surgery
cardiovascular system
Cardiology
Exercise Test
Radiology
medicine.symptom
Cardiology and Cardiovascular Medicine
business
medicine.drug
Echocardiography, Stress
Subjects
Details
- ISSN :
- 19167075
- Volume :
- 30
- Issue :
- 9
- Database :
- OpenAIRE
- Journal :
- The Canadian journal of cardiology
- Accession number :
- edsair.doi.dedup.....99359506f90bc0567e72518a7811e5b6