Stress testing for the evaluation of patients with mitral regurgitation

The emerging role of stress and particularly exercise echocardiography in mitral regurgitation has been recently emphasized. In fact, the evaluation of mitral regurgitation only under resting conditions might underestimate the full impact of the lesion and its clinical effects.

Exercise echocardiography can identify what otherwise might be considered as a moderate valve disease. Recently, worsening of mitral regurgitation severity, marked increase in pulmonary arterial pressure, limited contractile reserve, and impaired exercise capacity, together with the occurrence of symptoms during exercise echocardiography, provide the clinician with diagnostic and prognostic information that can contribute importantly to identify a subset of patients at higher risk, who may benefit from elective mitral valve surgery.

Exercise echocardiography has the advantages of its wide availability, low cost, and versatility for the assessment of mitral regurgitation severity. Furthermore, exercise echocardiography can help to unmask patients at a more advanced stage of the disease and could improve the management and the timing of surgery.