Diagnostic Testing: Initial Diagnosis TTE is the standard diagnostic test in the initial evalu- ation of patients with known or suspected VHD.1 4 LOE Level of Evidence LV left ventricle (left ventricular) LVEDD left ventricular end-diastolic dimension LVEF left ventricular ejection fraction LVESD left ventricular end-systolic dimension MDT multidisciplinary team MR mitral regurgitation MS mitral stenosis NOAC non vitamin K oral anticoagulant NYHA New York Heart Association PCI percutaneous coronary intervention PET positron emission tomography PMBC percutaneous mitral balloon commissurotomy RCT randomized controlled trial RV right ventricle (right ventricular) SAVR surgical aortic valve replacement TAVI transcatheter aortic valve implantation TEE transesophageal echocardiography (echocardiogram) TEER transcatheter edge-to-edge repair TR tricuspid regurgitation TTE transthoracic echocardiography (echocardiogram) UFH unfractionated heparin VHD valvular heart disease ViV valve-in-valve VKA vitamin K antagonist CLINICAL STATEMENTS AND GUIDELINES TTE allows accurate assessment of valve anatomy and etiology, concurrent valve disease, and associated ab- normalities, such as aortic dilation. Left ventricular (LV) anatomy and function are characterized by linear di- mensions, as well as by 2D and 3D volumes and ejec- tion fraction (LVEF), and it is recognized that decisions are most robust when based on sequential studies, giv- en the inherent measurement variability for these pa- Doppler echocardiography provides accurate noninvasive determination of valve hemodynamics.1,2,6 For stenotic lesions, key measurements are maximum velocity, mean gradient, and valve area. For regurgi- tant lesions, calculation of regurgitant orifice area, vol- ume, and fraction is performed, when possible in the context of a multiparameter severity grade based on color Doppler imaging, continuous- and pulsed-wave Doppler recordings, and the presence or absence of distal flow reversals. 