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About the value of Exercise stress Echocardiography

EACVI Valvular Imaging Box

Author : Dr. Erwan Donal.

Cardiology Services of RENNES's CHU.

Contact :



  • Asymptomatic Man
  • 75 years Old
  • Asthma
  • But no chest pain, no dyspnea or other recent symptoms
    • Sent by his Cardiologist for evaluation of an Aortic Valve Stenosis

Clinical case information


  • Mean PG > 40 mmHg
  • Vmax > 4m/s
  • IP < 25%
  • Effective Orifice Area 0.8 cm²
  • but NO symptom






  • At Rest
  • GLS -18.4%
  • LV EF 67%
  • BP 157/93 mm Hg

Exercise: Progressive increase in workload every 2 minutes 0, 30, 60…150 watts




  • At Max Exercise 150 watts
  • Lvot VTI 24 cm
  • AoV VTI 100 cm
  • Vmax 4.8m/s
  • Mean PG 65.9 mmHg
  • increase in MPG = 21.6 mm Hg



Already at 60 watts, the Mean Pressure gradient reached 60 mm Hg and the Vmax 4.8ms
Without any increase in Blood Pressure
But without ANY symptom.


What should we do?

  • Asymptomatic
  • But
    • Low increase in Blood Pressure during exercise
    • Increase in MPG > 20 mm Hg
  • But 150 watts
  • No symptom, no ECG abnormality during Exercise
  • And
  • NT proBNP = 162 pg/ml

Proposal :

  • Careful follow-up: visit at the heart valve unit every three months
  • Education of the patient in regard to exercise and symptoms
  • clear presentation to the patient of the plans for a possible surgery within the year