Patients with rheumatic mitral valve disease (n = 48) underwent treadmill stress echocardiography and were classified as those with mitral stenosis (n = 24) or those with mitral regurgitation with mild mitral stenosis (n = 24). Despite marked differences in mitral valve area (1.1 +/- 0.3 vs 2.1 +/- 0.6 cm(2), respectively; p <0.0001), systolic tricuspid gradients were similar both at rest (37 +/- 11 vs 37 +/- 13 mm Hg) and at peak exercise (60 +/- 16 vs 55 +/- 13 mm Hg, respectively). Following stress echocardiography, an invasive procedure or modification of medical treatment was performed or recommended in 51% of the study patients.