The Role of Stress in Valvular Heart Disease

Abstract

Echocardiography is the cornerstone for evaluation of valvular disease. The majority of recommendations for valve interventions are based on the presence of symptoms, valvular severity and haemodynamics assessed at rest. However, valve diseases have a dynamic component with changes influenced by patient’s heart rate, blood pressure, loading conditions and ventricular-arterial coupling. Imaging at rest could miss subclinical myocardial dysfunction. Exercise testing can evaluate valve disease during conditions which correspond to patient’s daily activities. Stress imaging can identify haemodynamic changes induced by exercise or pharmacological agents.