ABC | Volume 113, Nº1, July 2019

Statement Position Statement on Indications of Echocardiography in Adults – 2019 Arq Bras Cardiol. 2019; 113(1):135-181 Table 19 – Recommendations of stress echocardiography in aortic valve stenosis Recommendation Class of recommendation Level of evidence Low-dose dobutamine stress echocardiography to confirm symptomatic low-flow/low gradient AVS and reduced LVEF and to assess the presence of contractile reserve (stage D2) I B Stress echocardiography in asymptomatic patients with moderate or marked AVS (stages B and C1) to assess exercise-induced symptoms, abnormal responses to systemic or pulmonary arterial pressure, and behavior of gradients and left ventricular function IIa B Stress echocardiography in asymptomatic patients (or with mild or doubtful symptoms) with low-flow/low gradient AVS and preserved LVEF to differentiate true stenosis from aortic pseudostenosis IIb B Stress or dobutamine echocardiography in symptomatic marked AVS III C AVS: aortic valve stenosis; LVEF: left ventricle ejection fraction. Table 20 – Recommendations of transesophageal echocardiography in aortic valve stenosis* Recommendation Class of recommendation Level of evidence High acuity AVS with low-flow/low gradient and preserved LVEF (D3), for assessment of valve area (reassessment of LVOT measurement) and assessment of valve morphology, including degree of calcification I B Acute AVS with low flow/low gradient and reduced LVEF (D2) for assessment of valve morphology, including degree of calcification IIb B Disagreement between the severity of AVS and transthoracic examination and clinical evaluation I B Difficulty assessing AVS at transthoracic examination due to inadequate acoustic window I B Assessment of aortic valve annulus size and geometry in patients candidates for percutaneous aortic valve prosthesis implantation I B Monitoring of percutaneous implantation of aortic valve prostheses and results immediately after implantation (catheter, position, prosthesis function, regurgitation) I B Assessment of complications immediately after percutaneous implantation of the aortic prosthesis (hypotension, coronary occlusion, LV dysfunction, LVOT obstruction, marked mitral insufficiency, prosthesis displacement, tamponade, right ventricular perforation, gas embolism, aortic dissection) I B Early assessment (within 30 days) after percutaneous implantation of aortic prosthesis as to the degree of valvular or paravalvular regurgitation ) in the presence of suspected valve dysfunction I B Stroke after percutaneous implantation of aortic prosthesis in case of suspected valve dysfunction I B Assessment of the distance of the aortic valve annulus to the coronary sinus in patients candidates for percutaneous implantation of aortic valve prosthesis IIb B *3D, if available. AVS: aortic valve stenosis; LVEF: left ventricular ejection fraction; LVOT: left ventricular outflow tract; LV: left ventricle. Table 21 – Recommendations of transthoracic echocardiography in aortic regurgitation 153 Recommendation Class of recommendation Level of evidence Confirm the presence, etiology, and severity of acute or chronic AR I B In patients with dilation of the aortic root to assess the degree of AR and the magnitude of aortic dilatation I B Reassessment of patients with prior AR and change of symptoms or signs I B Annual reassessment of LV size and function in marked asymptomatic AR, with reduction of the interval to six months for the first examination, or if there are significant changes in diameters or LVEF on subsequent examination (stage C) I B Reassessment every one to two years in moderate asymptomatic AR (stage B) I C Reassessment every three to five years in asymptomatic mild AR (stage B) I C Reassessment in less than one year of hemodynamic severity and LV function in patients diagnosed with AR before or during pregnancy, or who will undergo situations that increase demand (non-cardiac surgery) IIa C AR: aortic regurgitation; LV: left ventricle; LVEF: left ventricle ejection fraction. 156