Abstract
Stress echocardiography is a widely utilised test in patients with known or suspected coronary artery disease (CAD), valvular heart disease and cardiomyopathies. Its advantages include the ubiquitous availability of echocardiography, lack of ionising radiation, choice of physiological or pharmacological stressors, good diagnostic accuracy and robust supporting evidence base. SE has evolved significantly as a technique over the past three decades and has benefitted considerably from improvements in overall image quality (superior resolution), machine technology (e.g. digital cine-loop acquisition and side-by-side image display) and development of second-generation ultrasound contrast agents that have improved reader confidence and diagnostic accuracy. The purpose of this article is to review the breadth of SE in contemporary clinical cardiology and discuss the recently launched British Society of Echocardiography (BSE) Stress Echocardiography accreditation scheme.
Highlights
Stress echocardiography was initially employed as a non-invasive means of assessing patients with suspected coronary artery disease (CAD) by comparing regional and global left ventricular systolic function at rest and on stress (1)
As 2-dimensional echocardiography became more widely available, a wealth of data accrued during the 1980s and 1990s demonstrating the feasibility, safety and accuracy of exercise (2), dobutamine (3) and dipyridamole (4) stress echocardiography, resulting in it becoming a mainstream clinical investigation for symptomatic patients with possible CAD
The limited image quality and sub-optimal endocardial border visualisation observed in certain patients was directly addressed by the development of transpulmonary ultrasound contrast
Summary
Stress echocardiography was initially employed as a non-invasive means of assessing patients with suspected coronary artery disease (CAD) by comparing regional and global left ventricular systolic function at rest and on stress (1). The limited image quality and sub-optimal endocardial border visualisation observed in certain patients was directly addressed by the development of transpulmonary ultrasound contrast. These microbubble agents significantly improved the interpreting clinician’s confidence and diagnostic accuracy, in particular if ≥2 adjacent myocardial segments were not clearly visualised (5). There is growing appreciation of the value of stress testing in patients with valvular heart disease These patients have traditionally been evaluated by resting echocardiography only, their symptoms are typically triggered by exertion. A modern SE operator must have the ability to assess stenotic and regurgitant valve lesions and cardiomyopathies, such as hypertrophic cardiomyopathy (HCM)
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