Evaluation
Table 3. Frequency of Echocardiograms in Asymptomatic
Patients With VHD and Normal 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
(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 2. 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
