Exercise testing in aortic stenosis and in mitral regurgitation

Abstract

The European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association (ACC/AHA) have placed renewed emphasis on the role of exercise testing to provide objective evidence of exercise capacity and symptom status in patients with valvular heart disease (Vahanian et al. 2007; Bonow et al. 2006). Exercise testing represents the first choice over pharmacological stress for risk stratification in asymptomatic patients with aortic stenosis (AS) or degenerative mitral regurgitation (MR) (Pierard and Lancellotti 2007; Picano et al. 2009). It has been shown to provide insights regarding exertional symptoms disproportionate to resting hemodynamics in patients with functional ischemic MR. When combined with echocardiography, although treadmill or bicycle may be used, supine bicycle exercise is the recommended technique in valvular heart diseases. Semi-supine exercise echocardiography offers the advantage that Doppler information, in addition to assessment of regional wall motion, can be evaluated during the different steps of the test (Rosca et al. 2011).