Exercise testing has an established role in the evaluation of patients with valvular
heart disease and can aid clinical decision making. Because symptoms may develop slowly
and indolently in chronic valve diseases and are often not recognized by patients
and their physicians, the symptomatic, blood pressure, and electrocardiographic responses
to exercise can help identify patients who would benefit from early valve repair or
replacement. In addition, stress echocardiography has emerged as an important component
of stress testing in patients with valvular heart disease, with relevant established
and potential applications. Stress echocardiography has the advantages of its wide
availability, low cost, and versatility for the assessment of disease severity. The
versatile applications of stress echocardiography can be tailored to the individual
patient with aortic or mitral valve disease, both before and after valve replacement
or repair. Hence, exercise-induced changes in valve hemodynamics, ventricular function,
and pulmonary artery pressure, together with exercise capacity and symptomatic responses
to exercise, provide the clinician with diagnostic and prognostic information that
can contribute to subsequent clinical decisions. Nevertheless, there is a lack of
convincing evidence that the results of stress echocardiography lead to clinical decisions
that result in better outcomes, and therefore large-scale prospective randomized studies
focusing on patient outcomes are needed in the future.