Stress echocardiography: introduction and pathophysiology

Abstract Stress echocardiography is the combination of two-dimensional 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 left ventricular regional function during stress. Among different stress modalities of comparable diagnostic and prognostic accuracy available, semisupine exercise is the most frequently used; dobutamine-the best test for viability assessment; dipyridamole-the safest and simplest pharmacological stress test; and the most suitable for combined wall motion-coronary flow reserve assessment. Identification of viable myocardium and evaluation of severity of valvular heart disease are additional recognized applications of stress echocardiography. In spite of its dependence upon operators’ training, stress echocardiography is today the best (most cost-effective and risk-effective) possible imaging modality to achieve the still elusive target of sustainable cardiac imaging in the field of non-invasive diagnosis of coronary artery disease.