Stress echocardiography for evaluation of hemodynamics: valvular heart disease, prosthetic valve function, and pulmonary hypertension.

A broad variety of diseases can affect dynamic cardiac function and contribute to exertional symptoms. Although hemodynamic data at rest may be sufficient to guide therapy in some patients with cardiovascular disease, medical and surgical decisions may be impacted by the cardiac response to stress and the ability to associate exertional symptoms with cardiac hemodynamic response. Stress echocardiography/ Doppler provides a unique noninvasive means to evaluate cardiovascular function and ehmodynamic responses during increased cardiac work. Specifically, stress echocardiographic/Doppler imaging allows assessment of the response to exercise of left and right ventricular function, transvalvular and prosthetic valve gradients, and right ventricular systolic pressure. It has substantial clinical use in the evaluation of patients with equivocal evidence of mitral stenosis, suspicion of dynamic mitral insufficiency or prosthetic valve dysfunction, aortic stenosis and impaired left ventricular systolic function, diseases associated with pulmonary hypertension or cor pulmonale, and among patients with dyspnea of unknown origin. The dynamic nature of cardiovascular disease and the broad spectrum of diseases that affect cardiac function make exercise echocardiography/Doppler an ideal tool ideal for the noninvasive assessment of patients with symptoms of exertional dyspnea.