Stress echocardiography and mitral valvular heart disease.

The European Society of Cardiology's updated guidelines emphasize the usefulness of exercise stress echocardiography in patients with valvular heart disease. Exercise-induced changes in valve hemodynamics should be assessed in patients with mitral valve disease. In asymptomatic patients with moderate or severe mitral regurgitation without left ventricular dysfunction/dilatation, exercise stress echocardiography may identify a subset of patients with reduced cardiac event-free survival who are at a higher risk of developing symptoms. In patients with mitral stenosis who are asymptomatic, the development of symptoms during exercise is strongly related to the kinetics of the changes in the systolic pulmonary arterial pressure.