Stress echocardiography in aortic valve disease

International audienceIn aortic valve disease, the role of stress echocardiography is well supported by the literature. Exercise stress echocardiography is a tool of choice in asymptomatic patients with aortic stenosis (AS). However, it remains strictly contra-indicated in patients with symptoms. During exercise, the changes in trans-aortic velocity and gradient, in systolic pulmonary arterial pressure and in left ventricular ejection fraction, are of clinical and prognostic interest. The dobutamine stress echocardiography in patients with AS and low flow-low gradient (i.e. with impaired left ventricular ejection fraction) is useful to differentiate true severe and pseudo severe AS, to assess flow reserve, and ultimately to guide decision making and stratify the risk of patients