Exercise testing and stress imaging in valvular heart disease

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Clinical Medicine

Background:

• Valvular heart disease (VHD) management relies on symptom status and resting assessments.
• Current guidelines emphasize exercise testing for symptom evaluation and stress imaging for dynamic valvular assessment.
• Subclinical myocardial dysfunction in VHD may be missed by resting evaluations.

Purpose of the Study:

• To review the role of exercise testing and stress imaging in VHD management.
• To highlight the prognostic value of stress imaging in various VHD types.
• To discuss the potential of stress imaging in optimizing surgical timing and risk stratification for VHD patients.

Main Methods:

• Review of recent studies and guidelines on exercise testing and stress imaging in VHD.
• Analysis of prognostic data from exercise echocardiography and stress cardiovascular magnetic resonance imaging.
• Discussion of the utility of dobutamine stress echocardiography for specific aortic stenosis cases.

Main Results:

• Exercise echocardiography shows prognostic value in severe aortic stenosis, moderate-severe mitral stenosis, and severe primary mitral regurgitation.
• Dobutamine stress echocardiography helps differentiate true from pseudosevere low-flow, low-gradient aortic stenosis.
• Prognostic data for stress imaging in aortic regurgitation and functional mitral regurgitation are less established, with limited data for right-sided VHD.

Conclusions:

• Stress imaging can enhance risk stratification and surgical timing in VHD beyond symptom status and resting data.
• While not the primary driver for surgery, stress imaging provides valuable prognostic information.
• Further randomized clinical trials are needed to confirm improved outcomes with stress imaging-guided VHD management.