Stress echocardiography: image acquisition and modalities

Abstract Stress echocardiography has evolved over the last 30 years but image interpretation remains subjective and burdened by the operator’s experience. The objective operator-independent assessment of myocardial ischaemia during stress echocardiography remains a technological challenge. Still, adequate quality of two-dimensional images remains a prerequisite to successful quantitative analysis, even using Doppler and non-Doppler based techniques. No new technology has proved to have a higher diagnostic accuracy than conventional visual wall motion analysis. Tissue Doppler imaging and derivatives may reduce inter-observer variability, but still require a dedicated learning curve and special expertise. The development of contrast media in echocardiography has been slow. In the past decade, transpulmonary contrast agents have become commercially available for clinical use. The approved indication for the use of contrast echocardiography currently lies in improving endocardial border delineation in patients in whom adequate imaging is difficult or suboptimal. Real-time three-dimensional echocardiography is potentially useful but limited by low spatial and temporal resolution. It is possible that these technologies may serve as an adjunct to expert visual assessment of wall motion. At present, these quantitative methods require further validation and simplification of analysis techniques.