Skip to main content
SpringerLink
Log in

Exercise Testing in Valvular Heart Disease

  • Chapter
Cardiovascular Prevention and Rehabilitation

  • 2098 Accesses

Abstract

Exercise testing (ET) has been the cornerstone in the diagnosis and prognostic evaluation of coronary artery disease (see Chapter 14).1,2 Even in apparently healthy men exercise testing provides important prognostic informations.3 Although ET was recently recommended in the management of asymptomatic patients with valvular heart disease (VHD),4,5 this recommendation is based on a small database. In the Euro Heart Survey on Valvular Heart Disease of the European Society of Cardiology, exercise testing was used in less than 8% of 5001 patients, evaluated in hospital or as an outpatient in 27 European countries. 6 The reasons for performing exercise testing in these patients are listed in Table 16-1.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Gibbons RJ, Balady RJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the ACC/AHA Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol 2002;40:1531–1540.

    Article  PubMed  Google Scholar 

  2. Gohlke H, Samek L, Betz P, Roskamm H. Exercise testing provides additional prognostic information in angiographically defined subgroups of patients with coronary artery disease. Circulation 1983;68:979–985.

    PubMed  CAS  Google Scholar 

  3. Bodegard J, Erikssen G, Bjørnholt JV, Gjesdal K, Liestøl K, Erikssen J. Reasons for terminating an exercise test provide independent prognostic information. 2014 apparently healthy men followed for 26 years. Eur Heart J 2005;26:1394–1401.

    Article  PubMed  Google Scholar 

  4. Bonow RO, Carabello B, de Leon AC Jr, et al. ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease). J Am Coll Cardiol 1998;32:1486–1588.

    Article  Google Scholar 

  5. Iung B, Gohlke-Bärwolf C, Tornos P, et al. Recommendations on the management of the asymptomatic patient with valvular heart disease. Eur Heart J 2002;23:1253–1266.

    Article  PubMed  CAS  Google Scholar 

  6. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J 2003;24:1231–1243.

    Article  PubMed  Google Scholar 

  7. Gibbons RJ, Beasley JW, Bricker JT, et al. ACC/AHA guidelines for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol 1997;30:260–315.

    Article  PubMed  CAS  Google Scholar 

  8. Dubach P, Froelicher VF, Klein J, Oakes D, Grover-McKay M, Friis R. Exercise-induced hypotension in a male population: criteria, causes and prognosis. Circulation 1988;78:1380–1387.

    PubMed  CAS  Google Scholar 

  9. Gibbons RJ, Hu DC, Clements IP, Mankin HT, Zinsmeister AR, Brown ML. Anatomic and functional significance of hypotensive response during supine exercise radionuclide ventriculography. Am J Cardiol 1987;60:1–4.

    Article  PubMed  CAS  Google Scholar 

  10. Ciampi Q, Betocchi S, Lombardi R, et al. Hemodynamic determinants of exercise-induced abnormal blood pressure response in hypertrophic cardiomyopathy. J Am Coll Cardiol 2002;40:278–284.

    Article  PubMed  Google Scholar 

  11. Olivotto I, Maron BJ, Montereggi A, Mazzuoli F, Dolara A, Cecchi F. Prognostic value of systemic blood pressure response during exercise in a community-based patient population with hypertrophic cardiomyopathy. J Am Coll Cardiol 1999;33:2044–2051.

    Article  PubMed  CAS  Google Scholar 

  12. Kim JJ, Lee CW, Park SW, et al. Improvement in exercise capacity and exercise blood pressure response after transcoronary alcohol ablation therapy of septal hypertrophy in hypertrophic cardiomyopathy. Am J Cardiol 1999;83:1120–1123.

    Article  Google Scholar 

  13. Butchart EG, Gohlke-Bärwolf C, Antunes MJ, et al. Recommendations for the management of patients after heart valve surgery. Eur Heart J 2005;26(22):2463–2471.

    Article  PubMed  Google Scholar 

  14. Borg GA. Psychophysical basis of perceived exertion. Med Sci Sports 1982;14:377–381.

    CAS  Google Scholar 

  15. Otto CM, Pearlman AS, Kraft CD, Miyake-Hull CY, Burwash IG, Gardner CJ. Physiology changes with maximal exercise in asymptomatic valvular aortic stenosis assessed by Doppler echocardiography. J Am Coll Cardiol 1992;20:1160–1167.

    Article  PubMed  CAS  Google Scholar 

  16. Otto CM, Burwash IG, Legget ME, et al. Prospective study of asymptomatic valvular aortic stenosis. Clinical, echocardiographic, and exercise predictors of outcome. Circulation 1997;95:2262–2270.

    PubMed  CAS  Google Scholar 

  17. Das P, Rimington H, Chambers J. Exercise testing to stratify risk in aortic stenosis. Eur Heart J 2005;26:1309–1313.

    Article  PubMed  Google Scholar 

  18. Areskog NH. Exercise testing in the evaluation of patients with valvular aortic stenosis. Clin Physiol 1984;4:201–208.

    PubMed  CAS  Google Scholar 

  19. Atterhög J-H, Jonsson B, Samualsson R. Exercise testing: A prospective study of complication rates. Am Heart J 1979;98:572–579.

    Article  PubMed  Google Scholar 

  20. Atwood JE, Kawanishi S, Myers J, Froelicher VF. Exercise testing in patients with aortic stenosis. Chest 1988;93:1083–1087.

    PubMed  CAS  Google Scholar 

  21. Gohlke-Bärwolf C, Gohlke H, Samek L, et al. Exercise tolerance and working capacity after valve replacement. J Heart Valve Dis 1992;1:189–195.

    PubMed  Google Scholar 

  22. Gohlke-Barwolf C, Roskamm H. Ergebnisse des Herzklappenersatzes. Prognose — Arbeits-und Leistungsfahigkeit — Berufliche Wiedereingliederung. Versicherungsmedizin 1992;44:163–168.

    PubMed  CAS  Google Scholar 

  23. Aviles RJ, Nishimura RA, Pellikka PA, Andree KM, Holmes DR Jr. Utility of stress Doppler echocardiography in patients undergoing percutaneous mitral balloon valvotomy. J Am Soc Echocard 2001;14:676–681.

    Article  CAS  Google Scholar 

  24. Armstrong WF, Zoghbi WA. Stress echocardiography: current methodology and clinical applications. J Am Coll Cardiol 2005;45:1739–1747.

    Article  PubMed  Google Scholar 

  25. Halloran KH. The telemetered exercise electrocardiogram in congenital aortic stenosis. Pediatrics 1971;47:31–39.

    PubMed  CAS  Google Scholar 

  26. Chandramouli B, Ehmke DA, Lauer RM. Exercise induced electrocardiographic changes in children with congenital aortic stenosis. J Pediatr 1975;87:725–730.

    Article  PubMed  CAS  Google Scholar 

  27. James FW, Schwartz DC, Kaplan S, Spilkin SP. Exercise electrocardiogram, blood pressure, and working capacity in young patients with valvular or discrete subvalvular aortic stenosis. Am J Cardiol 1982;50:769–775.

    Article  PubMed  CAS  Google Scholar 

  28. Nylander E, Ekman I, Marklund T, Sinnerstad B, Karlsson E, Wranne B. Severe aortic stenosis in elderly patients. Br Heart J 1986;55:480–487.

    PubMed  CAS  Google Scholar 

  29. Fletcher GF, Balady GJ, Amsterdam EA, et al. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 2001;104:1694–1740.

    PubMed  CAS  Google Scholar 

  30. Maffei S, Baroni M, Terrazzi M, et al. Preoperative assessment of coronary artery disease in aortic stenosis: a dipyridamole echocardiographic study. Ann Thorac Surg 1998;65:397–402.

    Article  PubMed  CAS  Google Scholar 

  31. Linderholm H, Osterman G, Teien D. Detection of coronary artery disease by means of exercise ECG in patients with aortic stenosis. Acta Med Scand 1985;218:181–188.

    Article  PubMed  CAS  Google Scholar 

  32. Lund O, Magnussen K, Knudsen M, Pilegaard H, Nielsen TT, Albrechtsen OK. The potential for normal long term survival and morbidity rates after valve replacement for aortic stenosis. J Heart Valve Dis 1996;5:258–267.

    PubMed  CAS  Google Scholar 

  33. Pellikka AP, Nishimura AR, Bailey KR, Tajik AJ. The natural history of adults with asymptomatic, hemodynamically significant aortic stenosis. J Am Coll Cardiol 1990;15:1012–1017.

    Article  PubMed  CAS  Google Scholar 

  34. Pellikka AP, Sarano ME, Nishimura RA, et al. Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up. Circulation 2005;111:3290–3295.

    Article  PubMed  Google Scholar 

  35. Amato MC, Moffa PJ, Werner KE, Ramires JA. Treatment decision in asymptomatic aortic valve stenosis: role of exercise testing. Heart 2001;86:381–386.

    Article  PubMed  CAS  Google Scholar 

  36. Bonow RO, Cheitlin MD, Crawford MH, Douglas PS. Task Force 3: valvular heart disease. J Am Coll Cardiol 2005;45:1334–1340.

    Article  PubMed  Google Scholar 

  37. Pelliccia A, Fagard R, Bjornstad HH, et al. for the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology; Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 2005;26:1422–1445.

    Article  PubMed  Google Scholar 

  38. Das P, Rimington H, Smeeton N, Chambers J. Determinants of symptoms and exercise capacity in aortic stenosis: a comparison of resting haemodynamics and valve compliance during dobutamine stress. Eur Heart J 2003;24:1254–1263.

    Article  PubMed  Google Scholar 

  39. Monin JL, Quere JP, Monchi M, Petit H, et al. Lowgradient aortic stenosis: operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics. Circulation 2003;108:319–324.

    Article  PubMed  Google Scholar 

  40. Borer JS, Hochreiter C, Herrold EM, et al. Prediction of indications for valve replacement among asymptomatic or minimally symptomatic patients with chronic aortic regurgitation and normal left ventricular performance. Circulation 1998;97:525–534.

    PubMed  CAS  Google Scholar 

  41. Greenberg B, Massie B, Thomas D, et al. Association between the exercise ejection fraction response and systolic wall stress in patients with chronic aortic insufficiency. Circulation 1985;71:458–465.

    PubMed  CAS  Google Scholar 

  42. Shen WF, Roubin GS, Choong CYP, et al. Evaluation of relationship between myocardial contractile state and left ventricular function in patients with aortic regurgitation. Circulation 1985;71:31–38.

    PubMed  CAS  Google Scholar 

  43. Kawanishi DT, McKay CR, Chandraratna PA, et al. Cardiovascular response to dynamic exercise in patients with chronic symptomatic mild-tomoderate and severe aortic regurgitation. Circulation 1986;73:62–72.

    PubMed  CAS  Google Scholar 

  44. Schön HR, Dorn R, Barthel P, Schömig A. Effects of 12 months quinapril therapy in asymptomatic patients with chronic aortic regurgitation. J Heart Valve Dis 1994;3:500–509.

    PubMed  Google Scholar 

  45. Lev EI, Sagie A, Vaturi M, Sela N, et al. Value of exercise echocardiography in rheumatic mitral stenosis with and without significant mitral regurgitation. Am J Cardiol 2004;93:1060–1063.

    Article  PubMed  Google Scholar 

  46. Hochreiter C, Borer JS. Exercise testing in patients with aortic and mitral valve disease: current applications. Cardiovasc Clin 1983;13:291–300.

    PubMed  CAS  Google Scholar 

  47. Stoddard MF, Prince CR, Dillon S, Longaker RA, Morris GT, Liddell NE. Exercise induced mitral regurgitation is a predictor of morbid events in subjects with mitral valve prolapse. J Am Coll Cardiol 1995;25:693–699.

    Article  PubMed  CAS  Google Scholar 

  48. Lancellotti P, Lebrun F, Piérard LA. Determinants of exercise-induced changes in mitral regurgitation in patients with coronary artery disease and left ventricular dysfunction. J Am Coll Cardiol 2003;42:1921–1928.

    Article  PubMed  Google Scholar 

  49. Lancelotti P, Troisfontaines P, Toussaint AC, et al. Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction. Circulation 2003;108:1713–1717.

    Article  Google Scholar 

  50. Lancellotti P, Gerard PL, Pierard LA. Long-term outcome of patients with heart failure and dynamic functional mitral regurgitation. Eur Heart J 2005;26:1528–1532.

    Article  PubMed  Google Scholar 

  51. Bettinardi O, Bertolotti G, Baiardi P, et al. Can anxiety and depression influence the six-minute walking test performance in post-surgical heart valve patients? A pilot study. Monaldi Arch Chest Dis 2004;62:154–161.

    Google Scholar 

  52. Kim HJ, Ahn SJ, Park SW, et al. Cardiopulmonary exercise testing before and one year after mitral valve repair for severe mitral regurgitation. Am J Cardiol 2004;93:1187–1189.

    Article  PubMed  Google Scholar 

  53. Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2006;48(3e):1–148.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Herz-Zentrum Bad Krozingen, Germany

    Christa Gohlke-Bärwolf

Authors
  1. Christa Gohlke-Bärwolf
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Public Health Department, Kalmar County, Oskarshamn, Sweden

    Joep Perk FESC

  2. Klinische Kardiologie II, Herz-Zentrum Bad Krozingen, Germany

    Helmut Gohlke FACC, FESC

  3. Institute of Health Sciences Department of Earth Sciences, Vrije University, Amsterdam, The Netherlands

    Irene Hellemans MD, (Speciality Cardiology), PhD

  4. Department of Cardiology, Vrije University Medical Center, Amsterdam, The Netherlands

    Irene Hellemans MD, (Speciality Cardiology), PhD

  5. Hôpital Broussais-HEGP, Assistance Publique-Hôpitaux de Paris, Paris, France

    Philippe Sellier MD

  6. Department of Cardiology, Technical University of Munich Munich Rehabilitation Center, München, Germany

    Peter Mathes MD, FACC, FESC

  7. Cardiac Rehabilitation Center, Bois Gilbert, Ballan Miré, France

    Catherine Monpère MD

  8. Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland

    Hannah McGee BA(Mod), PhD, RegPsycholFPsSI

  9. Swiss Cardiovascular Center Bern Cardiovascular Prevention and Rehabilitation University, Hospital Inselspital, Switzerland

    Hugo Saner MD

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Springer-Verlag London Limited

About this chapter

Cite this chapter

Gohlke-Bärwolf, C. (2007). Exercise Testing in Valvular Heart Disease. In: Perk, J., et al. Cardiovascular Prevention and Rehabilitation. Springer, London. https://doi.org/10.1007/978-1-84628-502-8_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-84628-502-8_16

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84628-462-5

  • Online ISBN: 978-1-84628-502-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation