Tools for Echocardiographic Calculations

Muhamed Saric, MD, PhD
New York University

Stress Testing: MS

Exercise Stress Testing for Mitral Stenosis

bulletTarget patient group: Stage C vs. D (patient with discrepancy between echo findings of mitral stenosis and symptoms)
bullet Indication:
bulletExercise 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)
bulletContraindication: General contraindications for exercise stress testing.
bulletEvidence: Class I; evidence C
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 stenosis):
bulletSymptoms: Exercise-induced dyspnea
bulletMS specific echo parameters:
bulletWorsening diastolic mitral gradient (no specific cutoff value in guidelines)
bulletIncrease in PA systolic pressure (specific cutoff value not given in guidelines; exercise PASP > 60 or 70 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 mitral balloon valvuloplasty or surgery.


Dobutamine Stress Echo for Mitral Stenosis

bulletDobutamine stress echo may also be used in mitral stenosis but exercise stress echo is preferred.


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.