The clinical use of stress echocardiography in ischemic heart disease

Abstract

Stress echocardiography is an established technique for the assessment of extent and severity of coronary artery disease. The combination of echocardiography with a physical, pharmacological or electrical stress allows to detect myocardial ischemia with an excellent accuracy. A transient worsening of regional function during stress is the hallmark of inducible ischemia. Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging or magnetic resonance, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician.The evidence on its clinical impact has been collected over 35 years, based on solid experimental, pathophysiological, technological and clinical foundations. There is the need to implement the combination of wall motion and coronary flow reserve, assessed in the left anterior descending artery, into a single test. The improvement of technology and in imaging quality will make this approach more and more feasible. The future issues in stress echo will be the possibility of obtaining quantitative information translating the current qualitative assessment of regional wall motion into a number. The next challenge for stress echocardiography is to overcome its main weaknesses: dependance on operator expertise, the lack of outcome data (a widesperad problem in clinical imaging) to document the improvement of patient outcomes. This paper summarizes the main indications for the clinical applications of stress echocardiography to ischemic heart disease.

Layer‐specific strain in dipyridamole stress echo: A new tool for the diagnosis of microvascular angina

“…From January 2016 to June 2017, we prospectively enrolled a population of patients with known or suspected CAD, approaching our echo lab to perform a DSE as second level examination. According to the document by Sicari et al . DSE indication included: CAD diagnosis; typical symptoms of angina and intermediate‐high pre‐test probability after a non‐diagnostic or non‐interpretable exercise ECG; evaluation for cardiac etiology of dyspnea; exclusion criteria included: poor acoustic window; severe valvular disease; lack of informed consent.…”

“…From January 2016 to June 2017, we prospectively enrolled a population of patients with known or suspected CAD, approaching our echo lab to perform a DSE as second level examination. According to the document by Sicari et al 3…”

Myocardial stunning by gated SPECT: An old tool reinvented in a stunning turn

“…In patients with significant coronary artery disease (CAD), supply demand mismatch during stress testing results in myocardial perfusion abnormality followed by abnormal segment contractility, an energy-dependent phenomenon, causing transient stunning of the myocytes. 7 While this is more common with exercise or dobutamine, vasodilator stress testing can also induce myocardial ischemia (steal-phenomenon). If the ischemic burden is significant, global LVEF may decrease at peak stress in up to half of patients.…”

“…5,6 Stress-induced new wall motion abnormality is highly specific for CAD and ischemia with imaging modalities that focus on myocardial motion such as echocardiography and cardiac magnetic resonance imaging. 7 With gated Tc-99m single-photon emission computed tomography (SPECT), reversible regional wall motion abnormalities with exercise have a specificity of 100% to detect significant CAD ([ 70% epicardial stenosis of a coronary artery on angiogram), with good correlation with coronary artery jeopardy score (R = 0.49, P \ 0.0001), although with limited sensitivity (53%). 8 After adjusting for Duke Treadmill Score and other covariates, reversible wall motion abnormality on stress gated SPECT remains an independent predictor of severe CAD.…”

Integração do estudo anatômico coronariano através da angiotomografia/escore de cálcio ao estudo funcional de perfusão miocárdica pelo PET-CT utilizando rubídio na investigação da doença arterial coronariana

“…Lista de símbolos 13 NH 3 amônia marcada com nitrogênio radioativo (nitrogênio-13-amonia) 15 OH 2 0 água marcada com oxigênio 18 FDG flúor-18 radioativo, Fluorodesoxiglicose 18 F-flurpiridaz fluorine-18-flurpiridaz 82 Rb rubídio 82 Sr estrôncio 82 Rb + AngioTC/EC (s/n = se necessário) 17…”