Complications of exercise and pharmacologic stress echocardiography

Abstract

Stress echocardiography is a diagnostic cardiovascular exam that is commonly utilized for multiple indications, including but not limited to the assessment of obstructive coronary artery disease, valvular disease, obstructive hypertrophic cardiomyopathy, and diastolic function. Stress echocardiography can be performed via both exercise and pharmacologic modalities. Exercise stress is performed with either treadmill or bicycle-based exercise. Pharmacologic stress is performed via either dobutamine or vasodilator-mediated (i.e., dipyridamole, adenosine) stress testing. Each of these modalities is associated with a low overall prevalence of major, life-threatening adverse outcomes, though adverse events are most common with dobutamine stress echocardiography. In light of the recent COVID-19 pandemic, the risk of infectious complications to both the patient and stress personnel cannot be negated; however, when certain precautions are taken, the risk of infectious complications appears minimal. In this article, we review each of the stress echocardiographic modalities, examine major potential adverse outcomes and contraindications, assess the risks of stress testing in the setting of a global pandemic, and examine the utilization and safety of stress testing in special patient populations (i.e., language barriers, pediatric patients, pregnancy).

Clinical Application of Exercise Stress Echocardiography in an Outpatient Pediatric Population

“…According to our results [1,25,27,47], echocardiography in association with stress ECG should be considered in the pediatric population, since stress ECG alone may be normal or provide a false-positive result (Figure 3) in most children, as noted in our population. Also taking into account safety reasons [48], the results of our study with exercise stress echocardiography, as well as scientific recommendations [20,[25][26][27][28]47], ESE should be performed if possible to clarify unexplained exercise-related symptoms.…”

Stress echocardiography in valvular heart disease

“…The most common complications of exercise stress echocardiography (ESE) were arrhythmias (sustained/nonsustained ventricular tachycardia, supraventricular tachycardia, and atrioventricular block) and ischemic events (acute myocardial infarction and unstable angina) (6,7). In addition, the potential risk of exercise-induced physical injury must be addressed to minimise the risk of mechanical complications (8). In addition to common contraindications to exercise testing such as unstable myocardial ischemia, uncontrolled arrhythmias, and severe symptomatic heart failure, it should be noted that symptomatic severe AS is a contraindication to ESE in the context of diagnosing VHD.…”