ABCDEG Stress Echocardiography in Aortic Stenosis

Area of Science:

• Cardiology
• Echocardiography
• Valvular Heart Disease

Background:

• Stress echocardiography (SE) is crucial for evaluating valvular heart disease when resting echocardiography and symptoms are discordant.
• Aortic stenosis (AS) diagnosis can be challenging, particularly in low-flow, low-gradient (LFLG) cases, necessitating advanced assessment techniques.

Purpose of the Study:

• To highlight the role of SE in assessing aortic stenosis (AS), especially in low-flow, low-gradient (LFLG) AS.
• To emphasize SE's ability to differentiate true severe AS from pseudo-severe AS by evaluating left ventricular contractile reserve (CR).
• To underscore the importance of SE in guiding treatment strategies for AS based on comprehensive patient phenotyping.

Main Methods:

• Utilizing rest and stress echocardiography (SE) to assess aortic valve morphology, gradients, and valve area.
• Employing low-dose dobutamine SE for symptomatic classical LFLG AS and exercise SE for asymptomatic AS in active patients.
• Implementing a comprehensive SE protocol (ABCDEG) in the StressEcho 2030 study to analyze clinical and echocardiographic phenotypes.

Main Results:

• SE effectively evaluates left ventricular (LV) contractile reserve (CR) in patients with reduced LVEF, crucial for LFLG AS.
• LV CR assessment using SE can distinguish pseudo-severe AS from truly severe AS.
• Observational data suggest potential benefits of early intervention in asymptomatic severe AS, supporting guideline recommendations for SE.

Conclusions:

• Stress echocardiography is essential for accurate AS assessment, particularly in LFLG variants.
• Comprehensive SE evaluation, including LV function and pulmonary congestion, aids in tailoring treatment strategies.
• Prospective studies like StressEcho 2030 are vital for advancing stress echo-driven treatment for AS.