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Combined exercise and imaging: key tool for clinical challenges
  1. Erwan Donal,
  2. Elise Paven,
  3. Elena Galli
  1. Cardiology, CHU Rennes, Rennes, Bretagne, France
  1. Correspondence to Dr Erwan Donal, Cardiology, CHU Rennes, Rennes 35033, France; erwan.donal{at}

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There is not that much evidence that exercise stress echocardiography (ESE) could change the way we deal with a patient. However, in 2019, 467 manuscripts have been published about this clinical and imaging tool.

For valvular heart diseases, there are valuable contributions, but no clear and accepted value acknowledged by guidelines.1 For heart failure, the recent consensus document on failure with preserved ejection fraction suggests a large recourse to ‘diastolic stress echocardiography’ to improve characterisation of patients with dyspnoea but with unclear diagnosis during rest examinations.2 For hypertrophic cardiomyopathy (HCM), Doppler echocardiography during exercise in the standing, sitting or semisupine position is recommended to detect provocable left ventricular outflow tract obstruction (LVOTO) and exercise-induced mitral regurgitation (level I, class B). ESE is recommended in symptomatic patients if bedside manoeuvres fail to induce LVOTO ≥50 mm Hg. Identification of LVOTO is important in the management of symptoms and in the assessment of risk of sudden cardiac death. Therefore, ESE is part of routine in many laboratories dealing with HCM.3

In patients with dilated cardiomyopathy (DCM), ESE may be used in the assessment of inducible ischaemia …

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  • Contributors All authors contributed to and approved this document.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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