Accuracy Of Stress Echocardiography Research Articles

Stress Echocardiography with Adenosinethreephosphate and Atrial Pacing in Diagnosis of Late Coronary Shunts Stenosis

The aim of the study was to evaluate diagnostic accuracy of stress echocardiography (stress echoCG) with combination of high doze АТР and atrial pacing in diagnosis of late coronary shunts stenosis.48 men aged from 45 to 64 (48,4 ± 1,6 years), 36 patients undergone mammarocoronary shunting, 12 patients undergone auto venous shunting. Stress echoCG with combination of high doze ATP and atrial pacing suggested shunts lesions in 44 patients, in 8 cases previously intact coronary arteries, approved with coronary angiography. Coronary angiographies reviled no coronary lesions in 24 patients > 70 % shunts restenosis, in 22 coronary stenosis from 50 up to 70 %. Accuracy, sensitivity and specificity of stress- EchoCG with combination of stress-agents in coronary shunts restenosis, as well as stenosis of previously intact coronary arteries were 100 %.

Real-world performance and accuracy of stress echocardiography: the EVAREST observational multi-centre study.

AimsStress echocardiography is widely used to identify obstructive coronary artery disease (CAD). High accuracy is reported in expert hands but is dependent on operator training and image quality. The EVAREST study provides UK-wide data to evaluate real-world performance and accuracy of stress echocardiography.Methods and resultsParticipants undergoing stress echocardiography for CAD were recruited from 31 hospitals. Participants were followed up through health records which underwent expert adjudication. Cardiac outcome was defined as anatomically or functionally significant stenosis on angiography, revascularization, medical management of ischaemia, acute coronary syndrome, or cardiac-related death within 6 months. A total of 5131 patients (55% male) participated with a median age of 65 years (interquartile range 57–74). 72.9% of studies used dobutamine and 68.5% were contrast studies. Inducible ischaemia was present in 19.3% of scans. Sensitivity and specificity for prediction of a cardiac outcome were 95.4% and 96.0%, respectively, with an accuracy of 95.9%. Sub-group analysis revealed high levels of predictive accuracy across a wide range of patient and protocol sub-groups, with the presence of a resting regional wall motion abnormalitiy significantly reducing the performance of both dobutamine (P < 0.01) and exercise (P < 0.05) stress echocardiography. Overall accuracy remained consistently high across all participating hospitals.ConclusionStress echocardiography has high accuracy across UK-based hospitals and thus indicates stress echocardiography is being delivered effectively in real-world practice, reinforcing its role as a first-line investigation in the assessment of patients with stable chest pain.

Real-world use and accuracy of stress echocardiography: preliminary insights from the EVAREST study

Abstract Background Stress echocardiography is a widely used, non-invasive imaging modality used to identify prognostically significant coronary artery disease. High levels of accuracy have been reported, however this is highly dependent on operator training and image quality. There are currently limited data available on the accuracy of stress echo in every day clinical practice. Purpose The EVAREST study links stress echo clinics in 30 NHS Hospital Trusts in England and therefore provides data to evaluate the performance and diagnostic accuracy of stress echo in “real-world” clinical practice. Methods Analysis was performed on the first 7415 patients recruited prospectively between 2015 and January 2020. Participants are included if they have undergone stress echo to investigate for ischaemic heart disease. Data is collected on medical history and stress echo performance. Participants are followed up for 12 months through health records and patient phone call, with all outcomes undergoing expert adjudication. A positive cardiac outcome is defined as initiation of anti-anginal medications, ≥70% stenosis on coronary angiography, revascularisation, confirmed acute coronary syndrome or cardiac-related death. Results Mean age of patients undergoing stress echo is 65±12.3 years and 56% are male. Average BMI is 28.9±5.6 kg/m2. 71.4% undergo dobutamine stress (DSE) and 28.4% exercise with &amp;lt;1% having a pacemaker-mediated stress. Contrast was used in 71.4% of studies. Stress echos were interpreted at time of clinic visit as positive for inducible ischaemia in 18.2% of patients. One-year outcome data is currently available for 1892 participants. Sensitivity and specificity for clinician prediction of a positive cardiac outcome was 88.7% and 94.4%, respectively. Positive and negative predictive value of stress echo was 76.4% and 97.6%, respectively. Conclusion EVAREST provides unprecedented, large-scale information on the “real world” use and accuracy of stress echo across different healthcare settings in the UK, demonstrating performance consistent with best practice. Ongoing data collection will be used to evaluate sources of heterogeneity in the predictive accuracy of stress echo and identify optimal approaches to further improve performance. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Ultromics Ltd., Lantheus Ltd.

Stress Echocardiography in the Assessment of Long-Term Outcomes After Percutaneous Coronary Intervention in Patients With Stable Coronary Heart Disease

To study the possibilities of stress echocardiography (EchoCG) in the assessment of clinical state of patients after percutaneous coronary intervention (PCI). We included into this study 80 patients with stable ischemic heart disease. After preliminary examination, all patients underwent PCI. Stress EchoCG was carried out in 6 and 12 months after PCI. Clinical effect assessed in 12 months after revascularization was good in 90% of patients. We registered significant increase of exercise capacity (from 97 to 118 W; p=0.001), increase of double product (from 232 to 275; p=0.009), decrease of myocardial ischemia volume (regional contractility impairment index before PCI 1.36, a year after PCI 1.16; p=0.001). The incidence of restenosis was 7.5%. Restenosis was accompanied by a deterioration of clinical status of patients (silent myocardial ischemia, angina recurrence). The accuracy of stress echocardiography in detecting myocardial ischemia in patients after PCI was 94%. Stress EchoCG has high diagnostic accuracy for detection of myocardial ischemia in patients after PCI during the first 12 months after revascularization.

Indian Academy of Echocardiography Guidelines and Manual for Performance of Stress Echocardiography in Coronary Artery Disease

Stress echocardiography is one of the most useful non-invasive diagnostic modalities for detection and evaluation of coronary artery disease (CAD). It is also very useful for assessment of cardiac response to hemodynamic stress in a variety of other cardiac and non-cardiac disorders. Given its cost-effectiveness, stress echocardiography is particularly suited for Indian scenario where the incidence of CAD is rising at an alarming rate and the astronomical expenditure required for its management is borne largely by the patients themselves. However, despite its unequivocal diagnostic value, stress echocardiography remains underutilized, particularly in India, due to the lack of adequate exposure and training in this modality. Unfortunately, while there is extensive literature available to document diagnostic accuracy of stress echocardiography, there are very few texts that actually describe how to perform stress echocardiography in real life. This Indian Academy of Echocardiography guideline document aims to fill this very void. This is a comprehensive 'how to do' document prepared with the objective of providing detailed description of the steps involved in performance and interpretation of stress echocardiography so that there is increased adoption of this important and clinically useful diagnostic modality in daily clinical practice. However, while stress echocardiography has several clinical applications, the present document is restricted to its main application, which is evaluation of CAD.

TCT-540 Diagnostic Accuracy of Stress Echocardiography Compared With Invasive Coronary Angiography With Fractional Flow Reserve for the Diagnosis of Haemodynamically Significant Stenosis(Es) in Patients With Known or Suspected Coronary Artery Disease

TCT-540 Diagnostic Accuracy of Stress Echocardiography Compared With Invasive Coronary Angiography With Fractional Flow Reserve for the Diagnosis of Haemodynamically Significant Stenosis(Es) in Patients With Known or Suspected Coronary Artery Disease

145 Stress Echocardiography Demonstrates Excellent Feasibility, Safety and Diagnostic Accuracy in Patients with Significant Obesity: First Results from the Stress Ultrasonography in Morbid Obesity (SUMO) Study

BackgroundSignificant obesity is an increasing global health problem. Obese individuals often have a clustering of cardiovascular risk factors such as hypertension, diabetes and dyslipidaemia. Thus, symptomatic patients often have a...

Accuracy of Stress Echocardiography in Detecting Ischemic Heart Disease, Experience at the Bangkok Heart Hospital 2012

OBJECTIVES: Stress echocardiography is a good test for detecting ischemic heart disease. The sensitivity, specicity and accuracy should be veried. This test was compared to standard coronary angiographic results. This is the rst study by Bangkok Heart Hospital’s echocardiography lab to verify the effectiveness of stress echocardiography. MATERIAL AND METHODS: This study was a retrospective study that reviewed data from records. The 149 selected cases underwent stress echocardiography and a coronary angiogram (within 2 months after the stress echocardiography) between 1st January and 31st December 2012. The sensitivity, specicity and accuracy were assessed. RESULTS: The overall sensitivity, specicity, and accuracy were 81.98%, 42.10%, and 71.81% respectively. There was a variation of sensitivity, specicity and accuracy in each day of the week. There were many factors such as number of cases, reporting physicians, technically poor studies (including poor echogenicity of subject), technician experience, abnormal wall motion at rest, atrial brillation and bundle branch block. The sensitivity ranged from 57.14 % to 92.3%. The specicity ranged from 16.67% to 70%. The accuracy ranged from 50.0 % to 86.67 %. CONCLUSION: Stress echocardiography is a good test for evaluating ischemic heart disease. Our echo lab had lower sensitivity, specicity and accuracy than other previous studies. The limitation of this study was that it was a retrospective study. But it showed our routine work. We hope this will help our echo lab to improve the quality of its stress echocardiography testing.

High Numbers of False-Positive Stress Tests Are the Result of Inappropriate Testing

Patients who underwent coronary angiography preceded by stress testing during the period January 2009 through March 2012 were evaluated using the CathPCI database. The predictive accuracy of stress echocardiography (SE) and single-photon emission computed tomography (SPECT) were determined and used to back calculate the pretest probability of the population being tested. In total, 2662 catheterizations were performed, 866 (33%) of which were preceded by stress imaging. Overall, the positive predictive values of SE and SPECT did not differ significantly (61% and 66%, P = .15) and were much lower in certain subgroups. The overall pretest probabilities of patients without a documented history of coronary artery disease undergoing SE and SPECT in the study population were estimated to be 18% and 27%, respectively. This study shows that stress testing is performed too often in low-risk patients in whom it is unlikely to improve clinical decision making.

Stress echocardiogaphy: A useful test for assessing cardiac risk in diabetes

Cardiovascular disease is the leading cause of death in patients with diabetes therefore prompt diagnosis and treatment of high risk groups is essential. Dobutamine stress echocardiography is a safe, cheap and reliable method for coronary artery disease diagnosis and provides important long term prognostic information. The diagnostic accuracy and prognostic power of this technique has been validated by a number of studies on patients with and without diabetes. This article discusses the application, interpretation, and accuracy of stress echocardiography both in the general population and in patients with diabetes. The role of advanced imaging modalites such as myocardial contrast agents and tissue Doppler imaging is also explored.

Contrast Stress Echocardiography

Echocardiographic contrast agents have great value in combination with stress echocardiography. Their conventional role is to enhance left ventricular borders during suboptimal imaging, and the test is widely, if not universally, applied for this purpose.1 The use of echocardiographic contrast agents unequivocally improves endocardial resolution,2,3 facilitating concordant test interpretation,4 and there are probable diagnostic benefits,5 especially for less-expert readers. The evaluation of myocardial perfusion with echocardiographic contrast agents, long considered a holy grail of echocardiography, has become feasible as a result of improved understanding of microbubble–ultrasound interaction, equipment development, and significant efforts from a relatively small number of clinical investigators. The development of a feasible approach for myocardial contrast echocardiography has led to a number of recent reports that demonstrate improvement in the accuracy of stress echocardiography,6,7 particularly for the identification of single-vessel disease, and the recognition of the true extent of coronary disease, a facet that is commonly underestimated with stress echocardiography. See p 1444 The article by Tsutsui et al8 in this issue of Circulation represents another landmark in the clinical evaluation of myocardial contrast echocardiography. These investigators evaluated the prognostic value of …

The Added Clinical Value of Second Generation Ultrasound Contrast Agents

Intravenous contrast echocardiography using second generation contrast agents improves wall motion analysis in difficult-to-image patients and increases diagnostic accuracy of stress echocardiography. New and still experimental technology enables simultaneous evaluation of myocardial perfusion and wall motion. First clinical and experimental studies demonstrate an acceptable diagnostic accuracy of intravenous contrast echocardiography in detecting stress-induced ischemia and in differentiating viable from irreversibly damaged myocardium. Current data encourage the use of intravenous contrast echocardiography to evaluate microvascular integrity in patients with unstable angina and in acute infarction following coronary revascularization. However, attenuation artefacts may limit interpretation of findings in basal myocardial segments. Standardization of the method on the basis of more solid data derived from large clinical trials is needed before introducing intravenous myocardial contrast echocardiography into clinical practice.

Prognostic value of stress echocardiography in stable angina or after myocardial infarction.

Stress echocardiography is increasingly used for the assessment of coronary artery disease and is valuable in the treatment of patients with known disease as well. Although several studies are available on the accuracy of stress echocardiography in the detection of coronary artery disease and evaluation of its severity, studies on the use of this technique for evaluation of prognosis are just now emerging. Over the past decade, few studies have investigated its prognostic value in different patient populations. The versatility and advantage of stress echocardiography lie in the fact that it provides information on both resting ventricular function and stress-induced ischemia, two important determinants of cardiac events. Exercise echocardiography with the bicycle or posttreadmill approach is used in subjects who can exercise and provides important additional prognostic data from physiologic exercise variables. In patients unable to exercise, pharmacologic stress echocardiography with dobutamine or vasodilators is used. Stress echocardiography has been shown to identify different populations of patients at risk of cardiac events, including those with stable or suspected coronary artery disease, those with acute myocardial infarction, and those scheduled for major noncardiac surgery. In the early postinfarct setting, exercise and vasodilator stress have been used more often, whereas dobutamine echocardiography has been used predominantly at low doses for the assessment of residual myocardial viability. This review focuses on recently published investigations evaluating the prognostic effect of stress echocardiography in patients with stable coronary artery disease or acute myocardial infarction.

Current status of stress echocardiography in the diagnosis of coronary artery disease.

Stress echocardiography is a cost-effective and reliable diagnostic test for patients with suspected coronary artery disease. Stress echocardiography should be used in preference to exercise electrocardiography as the primary test in patients with uninterpretable ST segments. It is attractive for use as the primary test in patients with coexisting valvular disease. It probably is the optimal test for women. Stress echocardiography should be used as a secondary test when the result of exercise electrocardiography is inconsistent with the clinical status. In patients requiring nonexercise stress testing, an imaging test is mandatory. The ability of stress echocardiography to identify the location and extent of myocardial ischemia makes it appropriate in situations where decisions regarding revascularization will be made on these grounds. The overall accuracy of stress echocardiography and perfusion scintigraphy is comparable in expert hands. but one must always consider the expertise of the operator and the quality of each test in the environment in which it is performed.