Peak treadmill exercise echocardiography: not feasible?

Value of exercise echocardiography for predicting mortality in elderly patients

“…This may further compromise sensitivity, because ischaemia may rapidly recover during the immediate post‐treadmill period. Imaging acquisition at peak exercise during treadmill stress testing has been traditionally considered unfeasible [32]; however, although more demanding than the post‐treadmill approach, it not only is feasible [33,34], but also has higher sensitivity and accuracy in our experience [13–15] and provides additional prognostic information over the latter for the prediction of mortality and cardiac events [35]; therefore, our results might have been different if only post‐exercise imaging had been employed. Finally, in the subset of patients with high likelihood of performing submaximal tests, the concomitant use of atropine has been reported to be useful during treadmill ExEcho [19].…”

Stress Echocardiography in Known or Suspected Coronary Artery Disease

“…Peak stress images were acquired with the patient upright and quickly walking, a technique often considered "not feasible" because of the body motion of the patient (4). However, this and earlier work from these authors (5,6) indicate that, although doubtlessly demanding, it is indeed feasible. For bicycle ergometry, special devices are available that allow tilting the patient to the left side during exercise, thus facilitating peak exercise echocardiography.…”

Exercise stress echocardiography: Where are we now?

“…Supine bicycle exercise is recommended because Doppler information can be obtained during the different stages of exercise[ 19 ] rather than during post-treadmill imaging when substantial and rapid changes in heart rate and loading conditions occur. We and the Peteiro group[ 4 , 68 , 69 ] disagree with those recommendations, and we conduct echocardiography during treadmill exercise. Additionally, supine exercise is not as physiologic as is treadmill exercise, the equipment is not nearly as widely available as is a treadmill, and the maximum VO 2 attained is at least 10% lower with a bicycle[ 70 ].…”