Stress echocardiography

The heart is stressed pharmacologically, for example, with dipyridamole or dobutamine.

The heart is visualised by 2D echocardiography.

Normal heart shows increased motility when stressed; ischaemic myocardium is hypokinetic.

This technique is dependent on the experience of the operator.

In a study of 302 patients investigating risk stratification of patients presenting to hospital with cardiac-sounding chest pain, non-diagnostic ECGs and negative cardiac Troponin (1)

• despite negative cardiac Troponin, 12% of patients with acute chest pain had significant coronary artery disease (CAD)
  • stress echocardiography was found to be superior to exercise ECG in discriminating between those patients with a low and intermediate risk of CAD and correctly identified patients with significant CAD, as well as conferring an excellent prognosis in those considered low risk
• in this study population, stress echocardiography significantly reduced the requirement for further tests to diagnose CAD compared to exercise ECG

A further study (2) found that stress echocardiography was superior to Thrombolysis In Myocardial Infarction (TIMI) risk score and exercise electrocardiography in the assessment of risk in patients with suspected acute coronary syndrome, nondiagnostic electrocardiogram, and negative troponin.

Reference:

1. Jeetley P et al. Stress echocardiography is superior to exercise ECG in the risk stratification of patients presenting with acute chest pain with negative Troponin. Eur J Echocardiogr. 2006 Mar;7(2):155-64.
2. Jeetley P et al.Prognostic value of myocardial contrast echocardiography in patients presenting to hospital with acute chest pain and negative troponin. Am J Cardiol. 2007 May 15;99(10):1369-7