Prognostische Bedeutung der Stressechokardiographie

Abstract

Appraisal of the risk to which outpatients with chest pain are exposed is an important clinical problem that frequently occurs. The need to decide in day-to-day practice between a conservative or invasive approach in patients with chest pain is often difficult and the decision has grave implications. Stress echocardiography (SE) is readily accessible, the technology is relatively inexpensive, it is familiar and simple to handle, and measurements can be made directly in patients. Even today, its importance has hardly declined at all compared to cardiac MRT or myocardial scintigraphy. Owing to the large number of cases treated, diagnostics and prognostic appraisal of CHD are still a challenge in medical and economic terms. According to the Federal Office of Statistics, a gross expenditure of 6,740 Euros was incurred for every patient > 65 years old in Germany in 2002. 1,650 Euros (24%) was spent on treating diseases of the cardiovascular system. The cumulative data on the prognostic significance of SE indicate a roughly three to four times higher incidence of events in patients with definitive ischemia than in patients in whom ischemia is not detected. Patients with negative SE findings have a very good prognosis and usually do not require invasive diagnostics. Accordingly, consistent use of SE could specifically identify patients in whom a future event will occur and to reduce the number of patients receiving invasive investigations. This selective procedure might reduce health service costs.

Long Term Outcomes in Stress Echocardiography: Ten Year Follow up of a Cohort in a Single Centre

“…What this studies expands on compared to previous work is that high reassurance provided by a stress echocardiogram in the short term [12] is replicated in the longer term, in terms of major cardiovascular events (P < 0.001) and mortality rates (statistically non significant).…”

Echocardiographic assessment of myocardial ischemia

“…SE is one of the most important tools for assessing myocardial ischemia (20,29,45) and viable myocardia (46,47), in addition being easy to use at the bedside (45,48). Developments in digital hardware and software and improvements in ultrasound techniques have yielded excellent results from SE regarding scanning for ischemia ( Figure 6) and risk assessment (45,(49)(50)(51)(52), screening after PTCA (53) and testing for anti-ischemic drug effects (54). Recent studies have demonstrated the advantages of exercise echocardiography from the prognostic perspective in patients with known and unknown CHD (20) and left bundle brunch block (55).…”