Table 1

Stress echocardiographic parameters in native valvular heart disease

	Symptom	Type of stress	Echocardiographic parameters with guideline recommendations1 2	Echocardiographic parameters with clinical recommendations3
Severe high-gradient AS	Asymptomatic	ESE	–	Flow reserve/contractile reserve Ex-induced PAP >60 mm Hg Ex-MG increase >20 mm Hg1
Severe low-gradient AS with preserved LVEF	Asymptomatic	ESE	–	MG and AVA during exercise Ex-induced PAP >60 mm Hg
Severe low-gradient AS with preserved LVEF	Symptomatic	DSE	–	MG and AVA at DES
Severe low-gradient AS with reduced LVEF	–	DSE	MG and AVA at DES,1 2 flow reserve/contractile reserve1	Flow reserve/contractile reserve
Severe AR	Asymptomatic	ESE	–	Flow reserve/contractile reserve Ex-induced PAP >60 mm Hg
Severe primary MR	Asymptomatic	ESE	–	Ex-induced PAP >60 mm Hg1 Flow reserve/contractile reserve Ex-increase in EROA >10 mm²
Haemodynamically significant MS	Asymptomatic	ESE or DSE	Ex-MG increase >15 mm Hg for ESE2	Ex-MG increase >15 mm Hg for ESE or >18 mm Hg for DES Ex-induced PAP >60 mm Hg for ESE

AR, aortic regurgitation; AS, aortic stenosis; DSE, dobutamine stress echocardiography; EROA, effective regurgitant orifice area; ESE, exercise stress echocardiography; Ex, exercise; LVEF, left ventricular ejection fraction; MG, mean pressure gradient; MR, mitral regurgitations; MS, mitral stenosis; PAP, systolic pulmonary artery pressure.