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Methodology of Stress Echocardiography



Key References

Stress Echocardiography Expert Consensus Statement--Executive Summary: European Association of Echocardiography (EAE) (a registered branch of the ESC)

Sicari R, Nihoyannopoulos P, Evangelista A, Kasprzak J, Lancellotti P, Poldermans D, Voigt JU, Zamorano JL
Comment:
In the last 10 years, stress echocardiography has reached its established rank in the diagnosis and prognosis of coronary artery disease. These guidelines conclude that nuclear cardiology and stress echocardiography provide comparable information on diagnosis accuracy for noninvasive detection of coronary disease, identification of myocardial viability and prognostic stratification.
Reference: Eur Heart J 2009; 30:278-89

  ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 appropriateness criteria for stress echocardiography: a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, American Society of Echocardiography, American College of Emergency Physicians, American Heart Association, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance: endorsed by the Heart Rhythm Society and the Society of Critical Care Medicine

Douglas PS, Khandheria B, Stainback RF, Weissman NJ, Peterson ED, Hendel RC, Stainback RF, Blaivas M, Des Prez RD, Gillam LD, Golash T, Hiratzka LF, Kussmaul WG, Labovitz AJ, Lindenfeld J, Masoudi FA, Mayo PH, Porembka D, Spertus JA, Wann LS, Wiegers SE, Brindis RG, Douglas PS, Patel MR, Wolk MJ, Allen JM
Comment: American guidelines
Reference: Circulation 2008; 117:1478-97 

The additive prognostic value of wall motion abnormalities and coronary flow reserve during dipyridamole stress echo

Rigo F, Sicari R, Gherardi S, Djordjevic-Dikic A, Cortigiani L, Picano E
Comment:
In the last 5 years, a major innovation changed the face and the diagnostic content of stress echocardiography: dual imaging of wall motion and coronary flow reserve with pulsed-Doppler imaging of the middistal left anterior descending coronary artery. Imaging coronary flow reserve expands the prognostic potential of stress echocardiography, since in the absence of wall motion negativity, the patient subset with reduced coronary flow reserve also have a more malignant prognosis.
Reference: Eur Heart J 2008; 29:79-88 

Transthoracic echocardiographic imaging of coronary arteries: tips, traps, and pitfalls

Rigo F, Murer B, Ossena G, Favaretto E
Comment:
In the same setting, with the same stress, it is now possible to image function and flow simultaneously and therefore catch both flow and function, with vasodilatator stone. Although coronary flow reserve in a technology-in-progress and has yet to reach its full maturity, it is now considered a new standard in the clinical application of stress echocardiography.
Reference: Cardiovasc Ultrasound 2008; 6:7

Stress echocardiography from 1979 to present

Armstrong WF, Ryan T
Comment:
In USA, exercise echocardiography is based on the posttreadmill approach with imaging at rest and as soon as possible during the recovery period.
Reference: J Am Soc Echocardiogr 2008; 21:22-8 

Head to head comparison between perfusion and function during accelerated high-dose dipyridamole magnetic resonance stress for the detection of coronary artery disease

Pingitore A, Lombardi M, Scattini B, De Marchi D, Aquaro GD, Positano V, Picano E
Comment:
Ischemic effect is the requiqite for functional imaging, usually with2D echocardiography but also performed with cardiovascular magnetic resonance.
Reference: Am J Cardiol 2008;101:8-14 

The diagnostic accuracy of pharmacological stress echocardiography for the assessment of coronary artery disease: a meta-analysis

Picano E, Molinaro S, Pasanisi E
Comment:
The sensitivity, specificity and accuracy of fast (or atropine-potentiated) high-dose dipyridamole is identical to dobutamine stress echocardiography, as shown by this meta-analysis including five studies with 435 patients.
Reference: Cardiovasc Ultrasound 2008; 6:30 

The prognostic value of Doppler echocardiographic-derived coronary flow reserve is not affected by concomitant antiischemic therapy at the time of testing

Sicari R, Rigo F, Gherardi S, Galderisi M, Cortigiani L, Picano E
Comment:
The combination of conventional wall motion analysis with 2D echocardiography and coronary flow reserve with pulsed Doppler flowmetry of the mid-distal left anterior descending artery has been shown to provide an added and complementary power of prognostication in patients with known or suspected coronary artery disease.
Reference: Am Heart J 2008; 156:573-9

American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography

Pellikka PA, Nagueh SF, Elhendy AA, FESC, Kuehl CA, Sawada SG.
Comment:
In comparison to the 1998 publication of the Recommendations for Performance and Interpretation of Stress Echocardiography, the present release include improvements in imaging equipment, refinements in stress testing protocols and standards for image interpretation,and important progress toward quantitative analysis.
Reference: J Am Soc Echocardiogr 2007; 20: 1021-1041.

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