The emerging role of exercise testing and stress echocardiography in valvular heart disease

Stress echocardiography has emerged as an important component of stress testing, in which the noninvasive assessment of dynamic changes in valve function, ventricular function, and hemodynamics can be coupled with assessment of exercise capacity and symptomatic responses. Surprisingly, this role is much more clearly established in American than European general cardiology guidelines, despite the larger and earlier acceptance of stress echocardiography in the European practice for the diagnosis of coronary artery disease. Stress echocardiography has the advantages of its wide availability, low cost, and versatility for the assessment of disease severity. In addition to its established applications in valvular heart disease, transthoracic Doppler echocardiography also has the potential to assess coronary flow reserve. The versatile applications of stress echocardiography can be tailored to the individual patient with aortic or mitral valve disease, both before and after valve replacement or repair. Hence, exercise-induced changes in valve hemodynamics, ventricular function, and pulmonary artery pressure, together with exercise capacity and symptomatic responses to exercise, provide the clinician with diagnostic and prognostic information that can contribute importantly to subsequent clinical decisions.