Applications of Stress Echocardiography in Mitral Valve Disease

Abstract

Although stress echocardiography is primarily used to exclude inducible myocardial ischemia, it also has several useful applications related to mitral valve functional assessment. Its main role relates to assessment of contractile reserve, which can be used to optimally time mitral valve surgery in the setting of significant mitral regurgitation (MR). Clinically, stress echocardiography is most often used in the setting of myxomatous mitral valve prolapse with severe regurgitation but an absence of symptoms. Exercise stress echocardiography allows physicians to assess the patient’s exercise capacity, investigate for exercise-induced pulmonary hypertension, and perhaps most importantly, assess the left ventricle’s response to exercise. Unmasking of impaired functional capacity, inducible pulmonary hypertension, precipitation of atrial arrhythmias, worsening of MR severity, or failure of augmentation in left ventricular systolic function with exercise all may suggest that the patient will benefit from mitral valve surgery. Ideally, this surgery should involve mitral valve repair, so structural information regarding leaflet morphology or thickening, subvalvular apparatus, and the degree of calcification are important observations to include for preoperative planning.