What are the assessment findings for valvular heart disease?

From the Guidelines

The assessment findings for valvular heart disease include a combination of history and physical examination, electrocardiogram (ECG), and transthoracic echocardiogram (TTE) as the standard initial diagnostic tests [ 1 ].

Initial Evaluation

• TTE is used to assess valve anatomy and etiology, concurrent valve disease, and associated abnormalities [ 1 ]
• History and physical examination are used to establish symptom severity, comorbidities, valve disease presence and severity, and presence of heart failure [ 1 ]
• ECG is used to establish rhythm, left ventricular function, and presence or absence of hypertrophy [ 1 ]

Further Diagnostic Testing

• Chest x-ray is used to assess heart size and presence or absence of pulmonary vascular congestion, intrinsic lung disease, and calcification of aorta and pericardium [ 1 ]
• Transesophageal echocardiography (TEE) is used to provide high-quality assessment of mitral and prosthetic valve, including definition of intracardiac masses and possible associated abnormalities [ 1 ]
• Cardiac magnetic resonance (CMR) is used to assess left ventricular volumes and function, valve severity, and aortic disease [ 1 ]
• Stress testing is used to give an objective measure of exercise capacity [ 1 ]
• Catheterization is used to provide measurement of intracardiac and pulmonary pressures, valve severity, and hemodynamic response to exercise and drugs [ 1 ]

Further Risk Stratification

• Biomarkers are used to provide indirect assessment of filling pressures and myocardial damage [ 1 ]
• TTE strain is used to help assess intrinsic myocardial performance [ 1 ]
• CMR is used to assess fibrosis by gadolinium enhancement [ 1 ]
• Stress testing is used to provide prognostic markers [ 1 ]
• Procedural risk is quantified by STS (Predicted Risk of Mortality) and TAVI scores [ 1 ]
• Frailty score is used to provide assessment of risk of procedure and chance of recovery of quality of life [ 1 ]

From the Research

Assessment Findings for Valvular Heart Disease

The assessment findings for valvular heart disease can be summarized as follows:

• Echocardiography is the primary imaging modality used for initial assessment and longitudinal evaluation of valvular heart disease 2
• Information obtained from echocardiography includes valve morphology and function, cardiac chamber size, wall thickness, ventricular function, and estimates of pulmonary artery pressures 2
• Cardiovascular magnetic resonance (CMR) has a significant clinical role in assessing valvular heart disease, particularly in cases where echocardiography is technically difficult or provides discordant results 2, 3
• CMR provides a comprehensive view of the entire heart without limitations from inadequate imaging windows or body habitus, and can obtain imaging data in any imaging plane prescribed by the scan operator 2
• The objectives of a comprehensive CMR study for evaluating mitral insufficiency include providing insight into the mechanism of mitral insufficiency, discerning the consequences of the lesions, and assessing left ventricular volume, left ventricular systolic function, and left atrial volumes 2

Diagnostic Approaches

Different diagnostic approaches are used to assess valvular heart disease, including:

• Echocardiography as the first-line test for assessing valvular heart disease 3, 4, 5
• CMR as a complementary test to provide additional information on valve disease severity and to plan the timing of intervention 3
• Electrocardiogram (ECG) and chest radiograph (CXR) as basic investigations to support diagnosis 4
• Invasive testing, if needed, to confirm diagnosis and assess severity 4

Management and Follow-up

The management and follow-up of valvular heart disease involve:

• Medical therapy as a bridge to definitive mechanical or surgical therapy 4, 5
• Annual follow-up by cardiology for patients with progressive valvular heart disease, with imaging performed based on the severity of valvular dysfunction 5
• Surgery or intervention recommended only when symptoms dictate or when changes in left ventricular function occur, and performed after discussion by a heart team including cardiologists and cardiac surgeons 5, 6