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Assessing function by echocardiography in valvular heart disease

  • Asymptomatic severe organic mitral regurgitation, presented by J Magne (Liege, BE) - Slides
  • Asymptomatic severe aortic stenosis, presented by C Szymanski (Douai, FR) - Slides
  • Aortic regurgitation, presented by V Delgado (Leiden, NL)
  • Multivalvular disease, presented by A Evangelista Masip (Barcelona, ES) - Slides
Non-invasive Imaging: Echocardiography

This very well attended session belonged to the “Cardiologists of the future” track; however, the audience profile reached far beyond the “in-training” group and the speakers provided the highest-level, up-to-date reviews covering both the current guidelines and the most recent clinical research data.

The first lecture on asymptomatic severe organic mitral regurgitation was delivered by J. Magne. This clinical situation is slightly controversial as truly asymptomatic severe insufficiency of mitral valve may be infrequent. However, low symptomatic patients do pose a decision problem which is addressed in slightly different manner in European and American guidelines (regarding exercise pulmonary pressure assessment). However, the detection of left ventricular (LV) dysfunction is of paramount importance. Therefore, assessment with exercise echocardiography and quantification using novel echocardiographic methods including speckle tracking-based deformation analysis may be helpful. Global ventricular strain emerges as a promising new index, probably more robust than traditional ejection fraction and suitable for functional reserve studies when calculated during exercise.

The second presentation by Catherine Szymanski referred to asymptomatic aortic stenosis. This entity has a growing importance due to demographic shift in European population and introduction of percutaneous valve implantation markedly modified risk calculation in some patient groups. Risk assessment is currently based on LV function measurement and stress testing. Novel aspects of the disease have been recently described in the form of low EF-low gradient and paradoxical low gradient-low flow (and preserved EF) variant. Biomarkers, functional indexes (e.g. 6-minute walk test) and novel pathophysiological parameters such as valvulo-arterial impedance reflecting ventriculoarterial coupling and thus total LV afterload have been also successfully tested as prognosticators , with a potential to influence the therapeutic decisions.

The topic of the third lecture presented by V. Delgado was aortic regurgitation. His somewhat less common form of valve disease also requires both careful quantification of the regurgitation intensity and early detection of left ventricular disease. There is a hope for a practical contribution of local functional indexes derived from tissue Doppler or speckle tracking, mainly strain or strain rate. Global left ventricular strain might again represent a reproducible, easy-to-obtain parameter.

The last presentation covered the complex field of multivalvular disease and was provided by Dr A. Evangelista Masip. This everyday problem (multivessel disease represents 15% of all valve surgery, according to ESC survey) was presented as a systematic overview of most common combinations of valve disease. In this case, both precise understanding of functional implications of specific disease type and detailed visualization of structural lesions (with three–dimensional echocardiography as a recent, efficient clinical tool) is critical to select appropriate therapies.

The presentations proved that echocardiography remains a basic, robust tool in valvular disease assessment. However, the decision pathways are expected to change soon due to evolution in analytic modalities but also upcoming era of percutaneous valvular interventions.




Assessing function by echocardiography in valvular heart disease

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.