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Stress echocardiography in patients with native valvular heart disease
  1. Patrizio Lancellotti1,2,
  2. Raluca Dulgheru1,
  3. Yun Yun Go1,
  4. Tadafumi Sugimoto1,
  5. Stella Marchetta1,
  6. Cécile Oury1,
  7. Madalina Garbi3
  1. 1 Departments of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liege, Belgium
  2. 2 Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
  3. 3 King’s Health Partners, King’s College Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Professor Patrizio Lancellotti, Domaine Universitaire du Sart Tilman, Batiment B35 Department of Cardiology, University Hospital, Université de Liège, CHU du Sart Tilman 4000 Liège, Belgium; plancellotti{at}


Valve stress echocardiography (VSE) can be performed as exercise stress echocardiography (ESE) or dobutamine stress echocardiography (DSE) depending on the patient’s clinical status, severity and type of valve disease. ESE combines exercise testing with two-dimensional grey scale and Doppler echocardiography during exercise. Thus, it provides objective assessment of symptomatic status (exercise test), as well as exercise-induced changes of a series of echocardiographic parameters (different depending on the valve disease type), which yield prognostic information in individual patients and help in a better treatment planning. DSE is useful in symptomatic patients with low-gradient aortic stenosis. It clarifies its severity and helps in assessing surgical risk in patients with severe disease and systolic dysfunction. It can be also used to test valve haemodynamics in asymptomatic patients with significant mitral stenosis unable to perform an exercise test or to test the left ventricle response, namely to test viability, in patients with ischaemic secondary mitral regurgitation. VSE has taught us that history taking, clinical examination and resting echocardiography give an ‘incomplete picture’ of the disease in patients presenting with a severe valve disease. Therefore, its use should be encouraged in such patients.

  • echocardiography
  • mitral Regurgitation
  • mitral Stenosis
  • aortic Stenosis

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  • Contributors PL and MG wrote the first draft. TS, YYG, RD, CO, SM provided critical review and the figures (practical cases).

  • Competing interests CO is Senior Research Associate at the belgian Funds for Scientific Research (FRS-FNRS).

  • Provenance and peer review Commissioned; externally peer reviewed.