Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC)

Abstract

Stress echocardiography is the combination of 2D echocardiography with a physical, pharmacological or electrical stress. The diagnostic end point for the detection of myocardial ischemia is the induction of a transient worsening in regional function during stress. Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician. Among different stresses of comparable diagnostic and prognostic accuracy, semisupine exercise is the most used, dobutamine the best test for viability, and dipyridamole the safest and simplest pharmacological stress and the most suitable for combined wall motion coronary flow reserve assessment. The additional clinical benefit of myocardial perfusion contrast echocardiography and myocardial velocity imaging has been inconsistent to date, whereas the potential of adding - coronary flow reserve evaluation of left anterior descending coronary artery by transthoracic Doppler echocardiography adds another potentially important dimension to stress echocardiography. New emerging fields of application taking advantage from the versatility of the technique are Doppler stress echo in valvular heart disease and in dilated cardiomyopathy. In spite of its dependence upon operator's training, stress echocardiography is today the best (most cost-effective and risk-effective) possible imaging choice to achieve the still elusive target of sustainable cardiac imaging in the field of noninvasive diagnosis of coronary artery disease.

Circulating Microparticles Decrease After Cardiac Stress in Patients With Significant Coronary Artery Stenosis

“…Intravenous dobutamine infusion was started at 5 μg/kg/min and increased by 10 μg/kg/min at 3-minute intervals to a maximum of 40 μg/kg/min until 85% of maximum age-predicted heart rate was reached. 12 If the peak maximum heart rate was not reached with dobutamine, 1.0 mg atropine was given, if the patient had no contraindication. The test was terminated before the maximum heart rate was reached if the patient developed significant ischemia or arrhythmia; and, if necessary for clinical stability, β-blockers were administered to reverse these conditions.…”

Myocardial viability as a criterion for successful endovascular treatment of patients with postinfarction cardiosclerosis

“…Для оценки жизнеспособности миокарда и динамики изменения локальной кинетики в послеоперационном периоде выполняли стресс-эхокардиографию с добутами-ном, которую проводили в соответствии со стандартным протоколом, включая определение прироста систоличе-ского утолщения миокарда в зонах с нарушенной локаль-ной сократимостью при введении малых доз добутамина, а также ухудшение имеющихся и/или появление новых нарушений региональной сократимости при введении больших доз препарата [1,13].…”

The Emerging Role of Exercise Testing and Stress Echocardiography in Valvular Heart Disease

“…Side effects are not infrequent with full-dose dobut- amine in unselected patients with normal or moderately reduced LV ejection fraction (9,28) and can occur in up to 20% of patients with low-flow, low-gradient AS (29). Arrhythmias are the most frequent serious adverse reactions.…”

“…The role of stress echocardiography for the assessment of the hemodynamic consequences of valvular lesions was initially proposed in the 1980s (6,7) but only recently gained recognition by specialized and general guidelines (1,2,8,9). In a number of patients with valvular heart disease, particularly those with low-flow, low-gradient aortic valve stenosis (AS), stress echocardiography provides additional information regarding severity of disease and hence aids in risk stratification and clinical decision making.…”

“…The exception is the use of pharmacologic stress echocardiography in patients with low-flow, low-gradient AS. Supine bicycle exercise is recommended because Doppler information can be obtained during the different stages of exercise (8,9), rather than post-treadmill imaging, when there are substan-tial and rapid changes in heart rate and loading conditions. On the other hand, supine exercise is not as physiologic as is treadmill exercise, and the equipment is not nearly as widely available as is the treadmill.…”