Dynamic stress evaluation of secondary mitral regurgitation

The emerging role of stress and particularly exercise echocardiography in secondary mitral regurgitation (SMR) has been recently emphasized. In fact, the evaluation of SMR only under resting conditions might underestimate the full impact of the lesion and its clinical effects. Exercise echocardiography can identify what otherwise might be considered as a moderate valve disease. The severity of SMR at rest is not related to exercise induced changes in SMR severity. Worsening of SMR severity, marked increase in pulmonary arterial pressure, limited contractile reserve, impaired exercise capacity, together with the occurrence of symptoms during exercise echocardiography provide the clinician with diagnostic and prognostic information that can contribute importantly to identify a subset of patients at higher risk who may benefit from combined mitral valve surgery. © 2015 Springer-Verlag London.