4
Evaluation
Table 5. Frequency of Echocardiograms in Asymptomatic
Patients With VHD and Normal Left Ventricular (LV)
Function
Valve Lesion
Stage AS
a
AR MS MR
Progressive
(stage B)
Every 3–5 y
(mild severity:
V
max
2.0–2.9 m/s)
Every 1–2 y
(moderate
severity: V
max
3.0–3.9 m/s)
Every 3–5 y
(mild severity)
Every 1–2 y
(moderate
severity)
Every 3–5 y
(mitral valve area
[MVA] >1.5 cm
2
)
Every 3–5 y
(mild severity)
Every 1–2 y
(moderate
severity)
Severe
(stage C)
Every 6–12 mo
(V
max
≥4 m/s)
Every 6–12 mo
Dilating LV:
more frequently
Every 1–2 y
(MVA 1.0–1.5 cm
2
)
Once every year
(MVA <1.0 cm
2
)
Every 6–12 mo
Dilating LV:
more frequently
Patients with mixed valve disease may require serial evaluations at intervals earlier than recommended
for single valve lesions.
a
With normal stroke volume.
Table 4. Initial Diagnostic Testing
Recommendations
COR LOE
TTE is recommended in the initial evaluation of patients with
known or suspected VHD to confirm the diagnosis, establish
etiolog y, determine severity, assess hemodynamic consequences,
determine prognosis, and evaluate for timing of intervention.
I B
TTE is recommended in patients with known VHD with any
change in symptoms or physical examination findings.
I C
Periodic monitoring with TTE is recommended in asymptomatic
patients with known VHD at intervals depending on valve lesion,
severity, ventricular size, and ventricular function.
I C
Cardiac catheterization for hemodynamic assessment is
recommended in symptomatic patients when noninvasive tests are
inconclusive or when there is a discrepancy between the findings
on noninvasive testing and physical examination regarding severity
of the valve lesion.
I C
Exercise testing is reasonable in selected patients with
asymptomatic severe VHD to
• confirm the absence of symptoms, or
• assess the hemodynamic response to exercise, or
• determine prognosis.
IIa B
