2026 focsused update incorporated into the Japanese society of echocardiography 2023 practice guidance for the implementation of stress echocardiography "stress echocardiography using the Valsalva maneuver".

In 2023, Based on the continued evidence of stress echocardiography, the new practical guideline that describes the safe and effective methodology of stress echocardiography is now created by Guideline Committee of the Japanese Society of Echocardiography and is designed to expand the use of stress echocardiography for valvular heart disease and heart failure with preserved ejection fraction (HFpEF), as well as ischemic heart disease, hypertrophic cardiomyopathy, and pulmonary hypertension. The Valsalva maneuver is essential for evaluating left ventricular diastolic function and diagnosing patent foramen ovale (PFO). Furthermore, in association with the recent insurance coverage for myocardial myosin inhibitors, a new drug for hypertrophic cardiomyopathy, the Valsalva maneuver has become increasingly important in the diagnosis of hypertrophic obstructive cardiomyopathy. Based on the above background, the Guideline Committee of the Japanese Society of Echocardiography prepared the practice guidance for "Stress echocardiography using the Valsalva maneuver" as the focused update incorporated into the "Practice guidance for the implementation of stress echocardiography."