Echocardiography and detection of coronary artery disease

Abstract Coronary artery disease provokes an imbalance between myocardial oxygen supply and demand inducing myocardial ischaemia and infarction. Myocardial ischaemia causes left ventricular regional dyssynergy (an early, sensitive, and specific marker of ischaemia) and global dysfunction (a late and non-sensitive sign). To date, echocardiography has been the technique of choice for the assessment of regional ventricular function, both in resting conditions and even more so during stress, in spite of the dependence of echocardiographic imaging on the patient’s acoustic window and on the experience of the cardiologist interpreting the study. The advantages of feasibility, safety, reliability, and unsurpassed temporal resolution allow the documentation under optimal conditions of a regional dysfunction, which can be extremely localized in space and transient in time. Stress echocardiography is the combination of 2D-echocardiography with a physical, pharmacological, or electrical stress. The diagnostic end-point for the detection of myocardial ischaemia is the induction of a transient worsening in regional function during stress. Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician. New emerging fields of application taking advantage from the versatility of the technique are Doppler stress echo in valvular heart disease and in post-ischaemic dilated cardiomyopathy. In spite of its dependence upon operator’s training, stress echocardiography is today the best (most cost-effective and risk-effective) possible imaging choice to achieve the still elusive target of sustainable cardiac imaging.