Tools for Echocardiographic Calculations

Muhamed Saric, MD, PhD
New York University

Stress Testing: AR

Exercise Stress Testing for Aortic Regurgitation

bulletTarget patient group: Stage C severe aortic regurgitation
bulletIndication: Exercise stress testing can be used to assess symptomatic status and functional capacity in patients with AR. Such testing is helpful in confirming patientsí reports that they have no symptoms with daily life activities and in assessing objective exercise capacity and symptom status in those with equivocal symptoms.
bulletContraindication: General contraindications for exercise stress testing.
bulletEvidence: None given in the 2014 ACC/AHA guidelines
bulletBrief overview: Only stage C patients (severe asymptomatic or vaguely symptomatic patients with severe aortic regurgitation) should be considered for exercise stress testing for aortic regurgitation per se.
bulletMonitoring: Supervision by physician or physician assistant as per protocol for other stress tests.
bulletWhen to stop exercise (Positive exercise echo end-points in aortic regurgitation):
bulletSymptoms: Exercise-induced angina; excessive dyspnea early in exercise
bulletAR specific echo parameters: Data on prognostic value of exercise-induced AI parameters are equivocal; no specific recommendation given in 2014 ACC/AHA guidelines.
bulletInterpretation: A patient with a positive stress echo using above criteria becomes a stage D patient and should be considered for AV replacement.


Dobutamine Stress Echo for Aortic Regurgitation

bulletThere is no role for DSE for evaluation of aortic regurgitation per se.


Nishimura RA, Otto CM, Bonow RO et al. 2014 AHA/ACC guideline 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. 2014 Jun 10;63(22):e57-185.