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Dr. Gregg Pressman
Response to exercise is very informative in patients with heart failure, CRT, valvular disease and may help to guide therapy
This was a well-attended session exploring emerging applications of exercise echocardiography. A general theme was that exercise echocardiography can reveal important findings not apparent on resting studies, and that these findings have diagnostic and prognostic value.Dr. Ha led off with a talk about heart failure with preserved ejection fraction. He reviewed his own work and that of others demonstrating diverse responses to exercise among those with diastolic dysfunction. For example, some patients with impaired relaxation have no symptoms while others have limiting dyspnoea on exertion, despite similar resting Doppler/echo findings. Symptomatic subjects show reduced diastolic reserve and have less of an increase in e’ while E/e’ increases more than in asymptomatic subjects.Dr. Herbots then spoke about exercise in patients receiving CRT. He observed that dyssynchrony can increase, decrease, or remain unchanged with exercise. In addition, the degree of mitral regurgitation varies with the degree of dyssynchrony. Finally, global and local contractile reserve measurements predict the response to CRT. These facts might help explain the 30% non-response rate in patients receiving CRT.Dr. Dulgheru next delivered a comprehensive review on uses of exercise echocardiography in valvular disease. Exercise can precipitate symptoms in “asymptomatic” patients. It is also useful in cases of aortic stenosis and mitral valve disease, where symptoms are out of proportion to findings at rest. Finally, changes in valve gradients, size of the mitral regurgitant orifice, and pulmonary pressure all have important prognostic value.Dr. La Gerche concluded with a fascinating talk on right heart hemodynamics during exercise. He noted that pulmonary systolic pressure increases linearly with increases in cardiac output. While guidelines have removed exercise pulmonary pressure from the definition of pulmonary hypertension there is strong evidence that patients with abnormal cardiac or pulmonary vascular physiology have an inappropriate rise in pulmonary pressures at a given cardiac output.
Emerging applications of stress echocardiography
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