ECHO 2013 / When (and how) to use Stress Testing in Valvular Heart Disease
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Change in MR Volume with Exercise Degenerative MV Disease
Magne, J. et al. JACC 2010;56:300-9
©2013 MFMER | 3259292-31
Symptom-free survival
SPAP at rest and during exercise
•Exercise PHT is associated with markedly low
2-year symptom-free survival, emphasizing the use of exercise echocardiography.
•An exercise SPAP>56mmHg accurately predicts the occurrence of symptoms.
Magne, J. et al. Circulation 2010;122:33-41
©2013 MFMER | 3259292-32
Prosthetic Heart Valves
•Normally and abnormally functioning prosthesis can produce similar estimated gradients at rest by TTE
•Stress echo may be valuable in confirming or excluding the presence of hemodynamically significant prosthetic valve stenosis or PPM
•Discordance between patient’s symptomatic status and the prosthetic valve hemodynamics measured at rest
©2013 MFMER | 3259292-33
Exercise Echocardiography and
Prosthetic Heart Valves
Mean gradient (mm Hg)
Aortic Prosthesis
140
120
100 Exercise
80
60 |
Patient #1 |
|
40
Patient #2
20
Rest
0
0.4 |
0.8 |
1.2 |
1.6 |
Mitral Prosthesis
70
60
50 Exercise
40 |
|
30 |
|
20 |
Patient #3 |
|
|
10 |
Patient #4 |
|
|
0 |
Rest |
|
2.0 0.4 0.8 1.2 1.6 2.0
Indexed EOA (cm2/m2) |
Indexed EOA (cm2/m2) |
Picano et al: JACC 54:2251, 2009
©2013 MFMER | 3259292-34
Disproportionate increase in transvalvular gradient >20 mmHg for aortic prostheses
or
>12mmHg for mitral prostheses indicates severe
prosthesis dysfunction or PPM
Picano et al. JACC 2009;54:2251-60
©2013 MFMER | 3259292-35
Increasing exertional dyspnea after mitral valve repair
©2013 MFMER | 3259292-36
Exercise Echo Doppler after Mitral Valve Repair
©2013 MFMER | 3259292-37
60 year old woman with exertional dyspnea and new atrial fibrillation
©2013 MFMER | 3259292-38
60 year old woman with exertional dyspnea and new paroxysmal atrial fibrillation
©2013 MFMER | 3259292-39
60 year old woman with exertional dyspnea and new atrial fibrillation
©2013 MFMER | 3259292-40