[The role of Doppler of effort in the indications for percutaneous valvuloplasty and/or mitral surgery in patients with a preserved functional class].

We have evaluated in this study the role of exercise Doppler echocardiography to establish the clinical indication of invasive procedures in patients with mitral stenosis and preserved functional class. Thirty-tree patients, mean age 45 +/- 9 years, underwent 35 exercise Doppler studies by supine bicycle ergometry with a 2 MHz nonimaging continuous wave Doppler probe. Sixteen patients were in N.Y.H.A. class I and 19 in class II. Peak and mean mitral gradient were obtained at rest, during, at maximal exercise and at recovery period, averaging at least 5 cardiac cycles. The data of 16 patients with mitral area at rest < 1.2 cm2 (group I) were compared with the data of 19 patients with mitral area at rest > 1.1 cm2 (group II). The mean gradient (mmHg) in the group I compared with respect group II was significantly higher at rest (9.5 +/- 3 vs 6 +/- 3, p < 0.01), step 1 (21 +/- 5 vs 14 +/- 6, p < 0.001), step 2 (26.4 +/- 5 vs 17.9 +/- 6, p < 0.001), step 3 (26.5 +/- 4 vs 20.7 +/- 6, p < 0.01), step 4 (29.8 +/- 5 vs 23.8 +/- 4, p < 0.05) and peak exercise (31.4 +/- 4 vs 21.9 +/- 6, p < 0.001). The functional capacity in mets was similar in both groups (6.7 +/- 1 vs 7.2 +/- 2, p = NS). Three patients of group I (15.7%) showed the same increase of gradient as group I. We conclude that exercise Doppler echocardiography allow identification of the haemodynamic severity of patients with mitral stenosis and preserved functional class. This technique could be a good tool in clinical indication of invasive procedures in these patients.