Echocardiography has provided mechanistic clarification to tricuspid valve insufficiency induced by device leads; notably, when the lead tip was in the interventricular septum or if the lead was shown to be impinging on a leaflet, the device lead was more likely to impede leaflet mobility (P < . 05), and interfering leads were associated with more significant tricuspid regurgitation than noninterfering leads (P < . 05) [58]. Echocardiographic assessment of the left atrium may improve insights to aortic and mitral valve dysfunction [59]. Dyspnea-Suspected Cardiac Origin Novel strain imaging applications have shown promise in characterizing LV changes in patients with aortic stenosis and aortic insufficiency [60]. Volume loop characteristics (area under receiver operating characteristic curve [AUC] = 0.99, 1.00, and 1.00; all P < . 01) showed improved discrimination relative to peak strain (AUC = 0.75, 0.89, and 0.76; P = . 06, <. 01, and . 08, respectively) and LV ejection fraction (AUC = 0.56, 0.69 and 0.69; all P > . 05) to distinguish aortic valve stenosis versus control, aortic valve regurgitation versus control, and aortic valve stenosis versus aortic valve regurgitation groups, respectively. Strain imaging has also shown promise in providing improved insight to aortopathy and aortic elasticity in patients with a bicuspid valve [61]. US Echocardiography Transthoracic Stress TTE stress may be useful in further characterization of mitral and aortic stenosis, for example, in setting of discrepant resting echocardiographic gradation of stenosis and patient symptoms [21,24], as well as evaluating symptoms and exercise capacity of patients. Stress echocardiography may be useful in determining eligibility for competitive sports [62], with exercise-induced changes to ventricular response and valvular lesion, as well as changes to right ventricular (RV) systolic pressure potentially aiding in decision making.
Dyspnea Suspected Cardiac Origin Ischemia Already Excluded . Echocardiography has provided mechanistic clarification to tricuspid valve insufficiency induced by device leads; notably, when the lead tip was in the interventricular septum or if the lead was shown to be impinging on a leaflet, the device lead was more likely to impede leaflet mobility (P < . 05), and interfering leads were associated with more significant tricuspid regurgitation than noninterfering leads (P < . 05) [58]. Echocardiographic assessment of the left atrium may improve insights to aortic and mitral valve dysfunction [59]. Dyspnea-Suspected Cardiac Origin Novel strain imaging applications have shown promise in characterizing LV changes in patients with aortic stenosis and aortic insufficiency [60]. Volume loop characteristics (area under receiver operating characteristic curve [AUC] = 0.99, 1.00, and 1.00; all P < . 01) showed improved discrimination relative to peak strain (AUC = 0.75, 0.89, and 0.76; P = . 06, <. 01, and . 08, respectively) and LV ejection fraction (AUC = 0.56, 0.69 and 0.69; all P > . 05) to distinguish aortic valve stenosis versus control, aortic valve regurgitation versus control, and aortic valve stenosis versus aortic valve regurgitation groups, respectively. Strain imaging has also shown promise in providing improved insight to aortopathy and aortic elasticity in patients with a bicuspid valve [61]. US Echocardiography Transthoracic Stress TTE stress may be useful in further characterization of mitral and aortic stenosis, for example, in setting of discrepant resting echocardiographic gradation of stenosis and patient symptoms [21,24], as well as evaluating symptoms and exercise capacity of patients. Stress echocardiography may be useful in determining eligibility for competitive sports [62], with exercise-induced changes to ventricular response and valvular lesion, as well as changes to right ventricular (RV) systolic pressure potentially aiding in decision making.