 | Target patient group: Stage C vs. D (patient with discrepancy
between echo findings of mitral stenosis and symptoms)
|
| Indication:
 | Exercise testing with Doppler or invasive hemodynamic assessment
is recommended to evaluate the response of the mean mitral gradient and
pulmonary artery pressure in patients with mitral stenosis when there is
a discrepancy between resting Doppler echocardiographic findings and
clinical symptoms or signs. (Level of Evidence: C) |
|
| Contraindication: General contraindications for exercise stress
testing. |
| Evidence: Class I; evidence C |
| Monitoring: Supervision by physician or physician assistant as
per protocol for other stress tests. |
| When to stop exercise (Positive exercise echo end-points in
mitral stenosis):
| Symptoms: Exercise-induced dyspnea |
| MS specific echo parameters:
 | Worsening diastolic mitral gradient (no specific cutoff value in
guidelines) |
| Increase in PA systolic pressure (specific cutoff value not given
in guidelines; exercise PASP > 60 or 70 mm Hg is used in some studies)
|
|
|
| Interpretation: A patient with a positive stress echo using
above criteria becomes a stage D patient and should be considered for
mitral balloon valvuloplasty or surgery. |
