ECHO 2013 / When (and how) to use Stress Testing in Valvular Heart Disease
.pdf
Change in Output and PCWP with Exercise
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6 |
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Cardiac |
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index |
4 |
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(L/min/m2) |
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2 |
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0 |
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0 |
5 |
10 |
15 |
20 |
25 |
30 |
35 |
PCWP (mm Hg)
CP1082496-59
©2013 MFMER | 3259292-41
63 year old woman with HCM
Recurrent Pulmonary Edema
E = 60 cm/s e’ = 5 cm/s
©2013 MFMER | 3259292-42
Stage 2 |
Stage 4 |
©2013 MFMER | 3259292-43
63 year old woman with HCM
Recurrent Pulmonary Edema
Rest |
Stage 2 |
Stage 4 |
©2013 MFMER | 3259292-44
After SL Nitroglycerin
©2013 MFMER | 3259292-45
63 yo woman with recurrent pulmonary edema
Baseline |
Exercise |
Baseline |
Stage 4 |
©2013 MFMER | 3259292-46
Take-Home Message
•If symptoms are mainly exertional, do echoDoppler evaluation with exercise as well as at rest
•With emerging data, ACC/AHA and ESC recommend exercise in asymptomatic patients with severe VHD
•Exercise induced higher gradient (AS, MS), PHT (AS, MS,MR), and larger regurgitant volume (MR) are prognostic in asymptomatic patients.
•Remember exercise Echo study for patients with dyspnea, and evidence of diastolic dysfunction
(e’ < 8 cm/sec)
©2013 MFMER | 3259292-47
Thank you for listening!
Oh.jae@mayo.edu
©2013 MFMER | 3259292-48
Hypertension and Exertional Dyspnea
No ischemia
E/E’ = 7
E = 50 cm/s DT = 250 ms
E’ = 7 cm/s
CP1082496-61
©2013 MFMER | 3259292-49
Exertional Dyspnea
Baseline |
Supine Bike |
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E = 50
DT = 250
E’ = 7
E/E’ = 7
TR = 2.4
E = 85
DT = 140
E’ = 7
E/E’ = 12
TR = 3.8
CP1082496-61
©2013 MFMER | 3259292-50