Stress echocardiography

Stress echocardiography is a widely used method for assessing coronary artery disease, due to the high diagnostic and prognostic value. While inducible ischaemia predicts an unfavourable outcome, its absence is associated with a low risk of future events. The evaluation of coronary flow reserve by Doppler adds prognostic information to that of standard stress test. Stress echocardiography is indicated in cases when exercise testing is unfeasible, uninterpretable, or gives ambiguous result, and when ischaemia during the test is frequently a false positive response, as in hypertensives, women and patients with left ventricular hypertrophy. Viability detection represents another application of stress echocardiography. The documentation of viable myocardium predicts an improved outcome following revascularization in ischaemic and following resynchronization therapy in idiopathic cardiomyopathy. Moreover, stress echocardiography can aid significantly in clinical decision making in patients with valvular heart disease through dynamic assessment of mitral insufficiency, transvalvular gradients and pulmonary artery systolic pressure. Among the various stress modalities, exercise is safer than pharmacologic stress, in which major complications are three times more frequent with dobutamine than with dipyridamole. Stress echocardiography provides similar accuracy than perfusion scintigraphy but a substantially lower cost, without environmental impact and with no radiation biohazards for the patient.