{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:59:47Z","timestamp":1791813587858,"version":"4.3.4"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T00:00:00Z","timestamp":1702512000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Valvular heart disease (VHD) has been a significant health problem, particularly in developed countries, in relation to the aging population. Recent developments in the management of VHD require a more accurate assessment of disease severity to determine the need for transcatheter interventions or open heart surgery. Stress echocardiography is a crucial imaging modality for identifying the underlying pathology of VHD. Optimal administration of exercise or intravenous drugs may reveal hemodynamic abnormalities under stress without posing an invasive risk. Therefore, the implementation of stress echocardiography is recommended for determining interventional indications and risk stratification in mitral regurgitation and aortic stenosis. In addition, recent evidence has accumulated regarding the usefulness of stress echocardiography in various conditions including mitral stenosis, aortic regurgitation, and post-interventional VHD. Here, we summarize the current evidence and future perspectives on stress echocardiography in VHD.<\/jats:p>","DOI":"10.3389\/fcvm.2023.1233924","type":"journal-article","created":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T15:21:51Z","timestamp":1702567311000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Stress echocardiography in valvular heart disease"],"prefix":"10.3389","volume":"10","author":[{"given":"Kensuke","family":"Hirasawa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Izumo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihiro J.","family":"Akashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,12,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1161\/CIRCULATIONAHA.119.043391","article-title":"Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990\u20132017","volume":"141","author":"Yadgir","year":"2020","journal-title":"Circulation"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1696","DOI":"10.1136\/heartjnl-2016-310894","article-title":"Epidemiology of valvular heart disease in a Swedish nationwide hospital-based register study","volume":"103","author":"Andell","year":"2017","journal-title":"Heart"},{"key":"B3","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1093\/ejechocard\/jen175","article-title":"Stress echocardiography expert consensus statement: european association of echocardiography (EAE) (a registered branch of the ESC)","volume":"9","author":"Sicari","year":"2008","journal-title":"Eur J Echocardiogr"},{"key":"B4","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur Heart J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e25","DOI":"10.1016\/j.jacc.2020.11.018","article-title":"2020 ACC\/AHA guideline for the management of patients with valvular heart disease: a report of the American college of cardiology\/American heart association joint committee on clinical practice guidelines","volume":"77","author":"Otto","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1016\/j.amjcard.2006.02.064","article-title":"International stress echo complication R. safety of stress echocardiography (from the international stress echo complication registry)","volume":"98","author":"Varga","year":"2006","journal-title":"Am J Cardiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1016\/j.echo.2007.08.028","article-title":"Safety of stress echocardiography supervised by registered nurses: results of a 2-year audit of 15,404 patients","volume":"21","author":"Kane","year":"2008","journal-title":"J Am Soc Echocardiogr"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1228613","DOI":"10.3389\/fcvm.2023.1228613","article-title":"Complications of exercise and pharmacologic stress echocardiography","volume":"10","author":"Lee","year":"2023","journal-title":"Front Cardiovasc Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1766","DOI":"10.1161\/CIRCULATIONAHA.116.023997","article-title":"Medical treatment of aortic stenosis","volume":"134","author":"Marquis-Gravel","year":"2016","journal-title":"Circulation"},{"key":"B10","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1007\/s11886-015-0601-0","article-title":"Evaluation of aortic stenosis: an update\u2013including low-flow states, myocardial mechanics, and stress testing","volume":"17","author":"Pierard","year":"2015","journal-title":"Curr Cardiol Rep"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2645","DOI":"10.1093\/eurheartj\/ehw096","article-title":"Low-gradient aortic stenosis","volume":"37","author":"Clavel","year":"2016","journal-title":"Eur Heart J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e739","DOI":"10.1161\/CIRCULATIONAHA.111.075853","article-title":"Low-flow\/low-gradient aortic stenosis","volume":"124","author":"Awtry","year":"2011","journal-title":"Circulation"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2251","DOI":"10.1016\/j.jacc.2009.07.046","article-title":"The emerging role of exercise testing and stress echocardiography in valvular heart disease","volume":"54","author":"Picano","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"40b","DOI":"10.1016\/S0828-282X(07)71009-7","article-title":"New concepts in valvular hemodynamics: implications for diagnosis and treatment of aortic stenosis","author":"Pibarot","year":"2007","journal-title":"Can J Cardiol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/j.echo.2010.02.002","article-title":"Validation of conventional and simplified methods to calculate projected valve area at normal flow rate in patients with low flow, low gradient aortic stenosis: the multicenter TOPAS (true or Pseudo severe aortic stenosis) study","volume":"23","author":"Clavel","year":"2010","journal-title":"J Am Soc Echocardiogr"},{"key":"B16","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/j.jacc.2017.11.052","article-title":"Dobutamine stress echocardiography for management of low-flow, low-gradient aortic stenosis","volume":"71","author":"Annabi","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1865","DOI":"10.1016\/j.jacc.2009.02.026","article-title":"Outcome after aortic valve replacement for low-flow\/low-gradient aortic stenosis without contractile reserve on dobutamine stress echocardiography","volume":"53","author":"Tribouilloy","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.1016\/j.jacc.2018.01.054","article-title":"Transcatheter aortic valve replacement in patients with low-flow, low-gradient aortic stenosis: the TOPAS-TAVI registry","volume":"71","author":"Ribeiro","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1390","DOI":"10.1093\/eurheartj\/ehq076","article-title":"Usefulness of exercise-stress echocardiography for risk stratification of true asymptomatic patients with aortic valve stenosis","volume":"31","author":"Marechaux","year":"2010","journal-title":"Eur Heart J"},{"key":"B20","doi-asserted-by":"publisher","first-page":"I377","DOI":"10.1161\/Circulationaha.104.523274","article-title":"Prognostic importance of quantitative exercise Doppler echocardiography in asymptomatic valvular aortic stenosis","volume":"112","author":"Lancellotti","year":"2005","journal-title":"Circulation"},{"key":"B21","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1161\/CIRCULATIONAHA.111.088427","article-title":"Determinants and prognostic significance of exercise pulmonary hypertension in asymptomatic severe aortic stenosis","volume":"126","author":"Lancellotti","year":"2012","journal-title":"Circulation"},{"key":"B22","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1016\/j.echo.2019.11.007","article-title":"Value of transvalvular flow rate during exercise in asymptomatic patients with aortic stenosis","volume":"33","author":"Hirasawa","year":"2020","journal-title":"J Am Soc Echocardiogr"},{"key":"B23","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.jacc.2009.12.073","article-title":"Exercise-induced changes in degenerative mitral regurgitation","volume":"56","author":"Magne","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1161\/CIRCULATIONAHA.110.938241","article-title":"Exercise pulmonary hypertension in asymptomatic degenerative mitral regurgitation","volume":"122","author":"Magne","year":"2010","journal-title":"Circulation"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1608","DOI":"10.1093\/eurheartj\/eht345","article-title":"Left ventricular contractile reserve in asymptomatic primary mitral regurgitation","volume":"35","author":"Magne","year":"2014","journal-title":"Eur Heart J"},{"key":"B26","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/S0002-8703(03)00173-X","article-title":"Relationship of ventricular longitudinal function to contractile reserve in patients with mitral regurgitation","volume":"146","author":"Haluska","year":"2003","journal-title":"Am Heart J"},{"key":"B27","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1161\/CIRCIMAGING.112.000162","article-title":"Prognostic significance of exercise-induced right ventricular dysfunction in asymptomatic degenerative mitral regurgitation","volume":"6","author":"Kusunose","year":"2013","journal-title":"Circ Cardiovasc Imaging"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1713","DOI":"10.1161\/01.CIR.0000087599.49332.05","article-title":"Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction","volume":"108","author":"Lancellotti","year":"2003","journal-title":"Circulation"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1528","DOI":"10.1093\/eurheartj\/ehi189","article-title":"Long-term outcome of patients with heart failure and dynamic functional mitral regurgitation","volume":"26","author":"Lancellotti","year":"2005","journal-title":"Eur Heart J"},{"key":"B30","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1093\/ejechocard\/jeq105","article-title":"Changes in mitral regurgitation and left ventricular geometry during exercise affect exercise capacity in patients with systolic heart failure","volume":"12","author":"Izumo","year":"2011","journal-title":"Eur J Echocardiogr"},{"key":"B31","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1007\/s12574-018-0404-6","article-title":"Prognostic value of exercise stress echocardiography in patients with secondary mitral regurgitation: a long-term follow-up study","volume":"17","author":"Suzuki","year":"2019","journal-title":"J Echocardiogr"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1454","DOI":"10.1016\/j.amjcard.2015.02.028","article-title":"Clinical significance of exercise pulmonary hypertension in secondary mitral regurgitation","volume":"115","author":"Lancellotti","year":"2015","journal-title":"Am J Cardiol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"970","DOI":"10.1016\/S0735-1097(02)02063-6","article-title":"Valsartan benefits left ventricular structure and function in heart failure: Val-HeFT echocardiographic study","volume":"40","author":"Wong","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1067\/mhj.2003.105","article-title":"Marked improvement in left ventricular ejection fraction during long-term beta-blockade in patients with chronic heart failure: clinical correlates and prognostic significance","volume":"145","author":"Metra","year":"2003","journal-title":"Am Heart J"},{"key":"B35","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1016\/j.jacc.2007.03.062","article-title":"Aldosterone receptor antagonism induces reverse remodeling when added to angiotensin receptor blockade in chronic heart failure","volume":"50","author":"Chan","year":"2007","journal-title":"J Am Coll Cardiol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1161\/CIRCULATIONAHA.120.052186","article-title":"Effect of empagliflozin on left ventricular volumes in patients with type 2 diabetes, or prediabetes, and heart failure with reduced ejection fraction (SUGAR-DM-HF)","volume":"143","author":"Lee","year":"2021","journal-title":"Circulation"},{"key":"B37","doi-asserted-by":"publisher","first-page":"883450","DOI":"10.3389\/fcvm.2022.883450","article-title":"Dynamic secondary mitral regurgitation: current evidence and challenges for the future","volume":"9","author":"Onishi","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"B38","doi-asserted-by":"publisher","first-page":"2134","DOI":"10.1093\/eurheartj\/ehm126","article-title":"Early and late effects of cardiac resynchronization therapy on exercise-induced mitral regurgitation: relationship with left ventricular dyssynchrony, remodelling and cardiopulmonary performance","volume":"28","author":"Madaric","year":"2007","journal-title":"Eur Heart J"},{"key":"B39","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1093\/ehjci\/jeaa200","article-title":"Prognostic impact of transcatheter mitral valve repair in patients with exercise-induced secondary mitral regurgitation","volume":"22","author":"Izumo","year":"2021","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"B40","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1161\/CIRCULATIONAHA.104.532498","article-title":"Modern management of mitral stenosis","volume":"112","author":"Carabello","year":"2005","journal-title":"Circulation"},{"key":"B41","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.echo.2016.10.016","article-title":"The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European association of cardiovascular imaging and the American society of echocardiography","volume":"30","author":"Lancellotti","year":"2017","journal-title":"J Am Soc Echocardiogr"},{"key":"B42","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1016\/j.echo.2011.01.006","article-title":"Early hemodynamic changes versus peak values: what is more useful to predict occurrence of dyspnea during stress echocardiography in patients with asymptomatic mitral stenosis?","volume":"24","author":"Brochet","year":"2011","journal-title":"J Am Soc Echocardiogr"},{"key":"B43","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1161\/CIRCULATIONAHA.119.040095","article-title":"Complexity of defining severe \u201cstenosis\u201d from mitral annular calcification","volume":"140","author":"Reddy","year":"2019","journal-title":"Circulation"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1845","DOI":"10.1007\/s10554-020-01898-2","article-title":"Exercise behavior of degenerative mitral stenosis","volume":"36","author":"Horn","year":"2020","journal-title":"Int J Cardiovasc Imaging"},{"key":"B45","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1016\/S0002-9149(98)00910-2","article-title":"Usefulness of the indexed effective orifice area at rest in predicting an increase in gradient during maximum exercise in patients with a bioprosthesis in the aortic valve position","volume":"83","author":"Pibarot","year":"1999","journal-title":"Am J Cardiol"},{"key":"B46","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1159\/000460274","article-title":"The role of stress echocardiography in valvular heart disease: a current appraisal","volume":"137","author":"Gentry Iii","year":"2017","journal-title":"Cardiology"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.1016\/S0735-1097(99)00360-5","article-title":"Hemodynamic and physical performance during maximal exercise in patients with an aortic bioprosthetic valve: comparison of stentless versus stented bioprostheses","volume":"34","author":"Pibarot","year":"1999","journal-title":"J Am Coll Cardiol"},{"key":"B48","doi-asserted-by":"publisher","first-page":"799285","DOI":"10.3389\/fcvm.2021.799285","article-title":"Impact of prosthesis-patient mismatch on hemodynamics during exercise in patients with aortic stenosis after transcatheter aortic valve implantation with a balloon-expandable valve","volume":"8","author":"Kameshima","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"B49","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1093\/ehjci\/jew025","article-title":"Recommendations for the imaging assessment of prosthetic heart valves: a report from the European association of cardiovascular imaging endorsed by the Chinese society of echocardiography, the inter-American society of echocardiography, and the Brazilian department of cardiovascular imaging","volume":"17","author":"Lancellotti","year":"2016","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"B50","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1161\/CIRCIMAGING.112.000688","article-title":"Functional significance of elevated mitral gradients after repair for degenerative mitral regurgitation","volume":"6","author":"Chan","year":"2013","journal-title":"Circ Cardiovasc Imaging"},{"key":"B51","doi-asserted-by":"publisher","first-page":"4","DOI":"10.3109\/14017431.2013.861077","article-title":"Exercise echocardiography predicts postoperative left ventricular remodeling in aortic regurgitation","volume":"48","author":"Forsberg","year":"2014","journal-title":"Scand Cardiovasc J"},{"key":"B52","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1161\/CIRCIMAGING.113.001177","article-title":"Decision making in asymptomatic aortic regurgitation in the era of guidelines: incremental values of resting and exercise cardiac dysfunction","volume":"7","author":"Kusunose","year":"2014","journal-title":"Circ Cardiovasc Imaging"},{"key":"B53","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1007\/s12574-016-0323-3","article-title":"Prognostic value of exercise left ventricular end-systolic volume index in patients with asymptomatic aortic regurgitation: an exercise echocardiography study","volume":"15","author":"Sato","year":"2017","journal-title":"J Echocardiogr"},{"key":"B54","doi-asserted-by":"publisher","first-page":"992","DOI":"10.1093\/ehjci\/jev019","article-title":"Detection of subtle left ventricular systolic dysfunction in patients with significant aortic regurgitation and preserved left ventricular ejection fraction: speckle tracking echocardiographic analysis","volume":"16","author":"Ewe","year":"2015","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"B55","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1016\/j.echo.2018.07.001","article-title":"Exercise hemodynamics after aortic valve replacement for severe aortic stenosis","volume":"31","author":"Carter-Storch","year":"2018","journal-title":"J Am Soc Echocardiogr"},{"key":"B56","doi-asserted-by":"publisher","first-page":"40008","DOI":"10.1038\/srep40008","article-title":"Predictors of exercise-induced pulmonary hypertension in patients with asymptomatic degenerative mitral regurgitation: mechanistic insights from 2D speckle-tracking echocardiography","volume":"7","author":"Kamijima","year":"2017","journal-title":"Sci Rep"},{"key":"B57","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.jcmg.2018.12.031","article-title":"Left atrial dynamics during exercise in mitral regurgitation of primary and secondary origin: pathophysiological insights by exercise echocardiography combined with gas exchange analysis","volume":"13","author":"Sugimoto","year":"2020","journal-title":"JACC Cardiovasc Imaging"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1233924\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T15:21:54Z","timestamp":1702567314000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1233924\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,14]]},"references-count":57,"alternative-id":["10.3389\/fcvm.2023.1233924"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2023.1233924","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,14]]},"article-number":"1233924"}}