Summary of stress echocardiography protocols including type of stress, sequence of image acquisition and adverse endpoints for each valve lesion
| Valve lesion | Associated features | Type of stress | Stress stages | Imaging sequence | Parameters measured | Adverse endpoints |
| Severe aortic stenosis | Asymptomatic, EF >50% | Exercise | Rest, low workload, peak stress | AV CW Doppler. LVOT PW Doppler. LVOT diameter (baseline.) LV views. TR CW Doppler. Colour flow MR. | Peak AV gradient. Mean AV gradient. AV area. DVI. LVEF, wall motion. PASP. Inducible MR. | Symptoms. BP response. ∆ MG 20 mm Hg. ∆ LVEF <5%. Exercise PASP >60 mm Hg. New regional WMA. |
| Low-flow, low-gradient aortic stenosis | Symptomatic | Dobutamine | Rest, low workload | AV CW Doppler. LVOT PW Doppler. LVOT diameter (baseline). LV views. | Peak AV gradient. Mean AV gradient. AV area. SVI. Flow rate. LVEF, WMSI. | True severe AS: good flow reserve with increase in MG >40 mm Hg and AV area <1.0 cm2. |
| Severe/moderate mitral stenosis | Asymptomatic severe or symptomatic moderate disease | Exercise, dobutamine | Rest, low workload, peak exercise. Rest, low workload, peak stress. | TR CW Doppler. MV CW Doppler. TR CW Doppler. MV CW Doppler. | PASP. Mean MV gradient. PASP. Mean MV gradient. | Symptoms. PASP >60 mm Hg. Exercise MG >15 mm Hg. Dobutamine-MG >18 mm Hg. |
| Severe mitral regurgitation | Asymptomatic, EF >60%, LVESD <45 mm, PASP <50 mm Hg | Exercise | Rest, low workload, peak exercise | TR CW Doppler. TAPSE. LV views. | PASP. TAPSE. LVEF. GLS. Wall motion. | Symptoms. PASP >60 mm Hg. ∆ LVEF <5%. ∆ GLS <2%. ∆ EROA >10 mm2. ∆ RV >15 mL. New regional WMA. |
| Moderate mitral regurgitation | Symptomatic, EF >50%, LVESD <45 mm, PASP <50 mm Hg | Exercise | Rest, low workload, peak exercise | MR PISA, VC. MR CW Doppler. TR CW Doppler. TAPSE. LV views. | EROA. Regurgitant volume. PASP. TAPSE. LVEF. GLS. Wall motion. | Symptoms. ∆ EROA >10 mm2. ∆ RV >15 mL. PASP >60 mm Hg. |
| Severe aortic regurgitation | Asymptomatic, EF >50%, LVESVI <25 mm/m2 | Exercise | Rest, low workload, peak exercise | LV views. Colour flow for MR. TR CW Doppler. | LVEF. GLS. Wall motion. Inducible MR. PASP. | Symptoms. ∆ LVEF <5%. New regional WMA. |
AS, aortic stenosis; AV, aortic valve; BP, blood pressure; CW, continuous wave; DVI, Doppler velocity inm index; EF, ejection fraction; EROA, effective regurgitant orifice area; GLS, global longitudinal strain; LV, left ventricular; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic diameter; LVESVI, left ventricular end-systolic volume index; LVOT, left ventricular outflow tract; PW, pulsed wave; MG, mean gradient; MR, mitral regurgitation; MV, mitral valve; PASP, pulmonary artery systolic pressure; PISA, proximal isovelocity surface area; RV, right ventricular; SVI, stroke volume index; TAPSE, tricuspid annular systolic plane excursion; TR, tricuspid regurgitation; WMA, wall motion abnormality; WMSI, wall motion score index; VC, vena contracta.