Ocena choroby zastawkowej serca za pomocą elektrokardiografii wysiłkowej i echokardiografii obciążeniowej: czy te badania są nadal potrzebne?

The role of exercise electrocardiography (ECG) and stress echocardiography (SE) in the management of patients with valvular heart diseases (VHD) has been reviewed in this article relying on the recent evidence and the recommendations of the European Society of Cardiology/European Association of Cardio-Thoracic Surgery (ESC/EACTS) and the American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the management of VHD. Both guidelines emphasise the role of exercise ECG to unmask objectively the occurrence of symptoms in patients, who deny symptoms or have doubtful symptoms; however, the role of SE to assess the haemodynamic component of VHD and unmask subclinical myocardial dysfunction is questioned. The above-mentioned guidelines strongly recommend deciding regarding valve surgery according to the presence of symptoms and the left ventricular (LV) morphological and functional parameters assessed at rest. SE can be useful in selected VHD patients for the determination of prognosis, clarification of symptoms and deciding on the timing of surgery. Despite existing evidence, there is still a need for randomised clinical outcome trials evaluating the role of stress imaging in the daily practise decision-making.