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The importance of contractile reserve in predicting exercise tolerance in asymptomatic patients with severe aortic stenosis

Jet van Zalen, Sveeta Badiani, Lesley M Hart, Andrew J Marshall, Louisa Beale, Gary Brickley, Sanjeev Bhattacharyya, Nikhil R Patel, and Guy W Lloyd

strain imaging, TVI is angle dependent, but it has the advantage of being much less dependent on overall 2D image quality making it useful in most patients and during stress echocardiography. Alternative means of estimating LV dysfunction is the use of

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Echocardiographic assessment of aortic stenosis: a practical guideline from the British Society of Echocardiography

Liam Ring, Benoy N Shah, Sanjeev Bhattacharyya, Allan Harkness, Mark Belham, David Oxborough, Keith Pearce, Bushra S Rana, Daniel X Augustine, Shaun Robinson, and Christophe Tribouilloy

annulus ( 99 , 100 ). Exercise stress echocardiography Key points The BSE does not recommend the routine use of exercise stress echocardiography for the assessment of AS. Exercise testing (without echocardiography) is

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The dilemma of ischemia testing with different methods

Maria Pia Donataccio, Claudio Reverberi, and Nicola Gaibazzi

CAD have the worst prognosis and hence false-negative results represent Achilles heel of stress echocardiography, when performed in its standard fashion, aiming only for reversible wall motion abnormalities without perfusion imaging or left anterior

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The echocardiography of replacement heart valves

John B Chambers

detected on TTE) Symptomatic patient and suboptimal TTE imaging Paraprosthetic mitral regurgitation of uncertain severity Thromboembolism despite therapeutic INR (to detect pannus or thrombus) Stress echocardiography is never

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British Society of Echocardiography Departmental Accreditation Standards 2019 with input from the Intensive Care Society

Sarah Ritzmann, Stephanie Baker, Marcus Peck, Tom E Ingram, Jane Allen, Laura Duffy, Richard P Steeds, Andrew Houghton, Andrew Elkington, Nina Bual, Robert Huggett, Keith Pearce, Stavros Apostolakis, Khalatabari Afshin, and the British Society of Echocardiography Departmental Accreditation and Clinical Standards Committees with input from the Intensive Care Society

following five modules: Transthoracic echocardiography (compulsory module) Transoesophageal echocardiography (TOE) Stress echocardiography (stress echo) Training to the BSE proficiency standard (compulsory module) Joint BSE and

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The assessment of mitral valve disease: a guideline from the British Society of Echocardiography

Shaun Robinson, Liam Ring, Daniel X Augustine, Sushma Rekhraj, David Oxborough, Allan Harkness, Patrizio Lancellotti, and Bushra Rana

(MR, AR and diastolic dysfunction). Advanced echocardiographic assessment Stress echocardiography The clinical indications for stress echo in patients with mitral valve disease can be divided into two categories: severe valve

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Ischaemia as a cause of LVOT gradient reversal in HCM

Camelia Demetrescu, Shelley Rahman Haley, and Aigul Baltabaeva

We present the case of a previously fit 84-year-old female with long-standing systemic hypertension and the echo phenotype of hypertrophic cardiomyopathy (HCM) – asymmetrical septal hypertrophy, significant resting left ventricular (LV) outflow obstruction and mitral regurgitation (MR) secondary to systolic anterior motion (SAM) of the mitral valve. Valsalva provocation caused an increase in LVOT dynamic gradient and MR severity. The patient presented with a progressive decrease in exercise capacity along with chest pain relieved by rest or sublingual GTN. Exercise stress echo demonstrated a paradoxical response with reduction of both LVOT gradient and severity of MR. There was evidence of inducible regional wall motion abnormalities associated with no change in LV cavity size. Coronary angiogram revealed significant triple vessel disease.

Learning points:

  • 20% of adult HCM patients over the age of 45 years have been shown to have coexistent coronary artery disease (CAD) that is associated with a reduced overall survival. Diagnosis of CAD in patients with HCM is difficult to make based on clinical grounds because of the high incidence of angina in patients with HCM but no CAD.

  • Reduction of LVOT gradient with stress in patients with HCM (in the absence of a vaso-vagal response) may indicate ischaemia due to significant multivessel epicardial CAD, including left mainstem stenosis. Hence, this finding during stress echocardiography suggests that further investigation of the coronaries should be considered.

  • Exercise stress echocardiography has not been validated for the assessment of ischaemia secondary to epicardial coronary disease in patients with HCM because ischaemia in this group of patients is often caused by multiple mechanisms, including microvascular ischaemia and myocardial bridging.

  • Comparative assessment of rest and peak exercise 2D strain may add incremental value in identifying regional wall motion abnormalities, which may be difficult to distinguish by eye in hypertrophied, dynamic myocardium.

  • A paradoxical response to exercise with significant decrease in LVOT obstruction and MR has been reported in the literature. This is often associated with a trend toward increased exercise capacity and better prognostic outcomes. Our clinical case presents a significant decrease in LVOT obstruction and MR that was associated with a trend toward reduced exercise capacity and was caused by ischaemia.

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Artificial intelligence and echocardiography

M Alsharqi, W J Woodward, J A Mumith, D C Markham, R Upton, and P Leeson

regional wall motion is also important in stress echocardiography to identify patients with prognostically significant coronary disease. Echocardiography allows real-time visualisation of myocardial contractility during stress and by comparing left

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Prognostic value of resting myocardial contrast echocardiography: a meta-analysis

Lijun Qian, Feng Xie, Di Xu, and Thomas R Porter

accuracy of qualitative MP and WM analysis in patients with suspected symptomatic CAD and nondiagnostic ST findings. Patients undergoing resting MP and WM analysis prior to planned stress echocardiography were included, if the predictive value of resting MP

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Cardio-oncology: what you need to know now for clinical practice and echocardiography

Carolyn M Larsen and Sharon L Mulvagh

biomarkers for early detection of cardiotoxicity. However, the results have been mixed as to whether elevation in natriuretic peptides predicts subsequent cardiac dysfunction ( 5 ). Stress echocardiography is also being studied for a potential role in the