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stress echocardiography

Indications: - uninterpretable ECG stress testing [2] - information about a particular region of myocardium at risk is needed [1] - normal ECG stress testing with high index of suspicion for coronary artery disease [2] Procedure: - exercise or dobutamine stress used in connection with echocardiography in the evaluation of heart motion in patients with suspected coronary artery disease - study completed in < 1 hour Clinical significance: - in patients with significant coronary artery disease (CAD), stress induces segmental wall motion abnormalities in the region of distribution of the diseased vessels - left ventricular dilatation occurs when large areas are involved - myocardial viability may be determined by identifying increased wall motion in myocardial segments akinetic at baseline, for example increased LV ejection fraction with dobutamine infusion [3] - cardiac valve function can be assessed - pulmonary pressures may be assessed Sensitivity for detecting coronary stenosis of 50-70% is: - 70-80% for single vessel disease - > 90% for left main & 3 vessel coronary artery disease Notes: - image quality may be suboptimal in some patients but can be improved using microbubble transpulmonary contrast [1]

Related

coronary artery disease; coronary atherosclerosis (CAD)

Specific

dobutamine stress echocardiography exercise stress echocardiography

General

echocardiography cardiac stress testing

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998, 2015
  2. Bouzas-Mosquera A et al Prediction of mortality and major cardiac events by exercise echocardiography in patients with normal exercise electrocardiographic testing. J Am Coll Cardiol 2009 May 26; 53:1981. PMID: 19460612 - Flachskampf FA and Rost C. Stress echocardiography in known or suspected coronary artery disease: An exercise in good clinical practice. J Am Coll Cardiol 2009 May 26; 53:1991. PMID: 19460613
  3. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022