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Table 1 Proposal of Echo-Doppler exercise echocardiography

From: Need for a standardized protocol for stress echocardiography in provoking subaortic and valvular gradient in various cardiac conditions

Protocol Comments, references
1. Period of 12-h fasting before exercise [7]
2. Physiological exercise test for LVOTG provocation  
A/ Pre-exercise stage – echocardiography first in supine position and then in upright position In some patients rapid emergence or increase in LVOTG has been reported after mere standing prior to orthostatic stress testing; under such circumstances, exercise provocation is not only unnecessary but even contraindicated, because of the risk of syncope.
B/ Position during exercise – upright  
C/ Exercise gradient monitoring – continuous  
D/ Moment of gradient measurement by Doppler echocardiography – peak exercise  
E/ Mode of exercise – treadmill bicycle can be confidently used to acquire peak images, but peak O2 consumption is lower than that achieved by treadmill, which might lead to lower sensitivity. In addition, in contrast to treadmill, leg discomfort or lack of leg strength is a common reason for terminating prematurely the bicycling test.
F/ Termination of test – symptom-limited; alternatively, pre-specified heart rate/workload (or combination).
G/ Post-exercise recovery – continuous monitoring of LVOTG in upright position  
Full protocol in treadmill 2A-G [813]