Tools for Echocardiographic Calculations

Muhamed Saric, MD, PhD
New York University

Stress Testing: MR

Exercise Stress Testing for Mitral Regurgitation

bulletTarget patient group: Stage B and C of primary (degenerative) mitral regurgitation; no specific guidelines given for secondary (functional) MR.
bullet Indication:
bulletExercise hemodynamics with either Doppler echocardiography or cardiac catheterization is reasonable in symptomatic patients with chronic primary MR where there is a discrepancy between symptoms and the severity of MR at rest (stages B and C)
bulletExercise treadmill testing can be useful in patients with chronic primary MR to establish symptom status and exercise tolerance (stages B and C).
bulletContraindication: General contraindications for exercise stress testing.
bulletEvidence: Class IIA; evidence B
bulletMonitoring: Supervision by physician or physician assistant as per protocol for other stress tests.
bulletWhen to stop exercise (Positive exercise echo end-points in mitral regurgitation):
bulletSymptoms: Exercise-induced dyspnea
bulletMR specific echo parameters:
bulletWorsening MR
bulletIncrease in PA systolic pressure (specific cutoff value not given in guidelines; exercise PASP > 60 mm Hg is used in some studies)
bulletInterpretation: A patient with a positive stress echo using above criteria becomes a stage D patient and should be considered for MV repair or replacement.


Dobutamine Stress Echo for Mitral Regurgitation

bulletThere is no role for DSE for evaluation of mitral 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.