Overview of stress echocardiography
- Adelaide M Arruda-Olson, MD, PhD
Adelaide M Arruda-Olson, MD, PhD
- Assistant Professor of Medicine
- Mayo Clinic
Echocardiography enables evaluation of cardiac function at rest, during pharmacologic stress, and during or immediately following dynamic exercise. Exercise two-dimensional (2D) imaging is used primarily to detect the presence and extent of coronary artery disease by provoking regional ischemia with resulting wall motion abnormalities. The addition of exercise Doppler permits evaluation of valvular function, pulmonary artery pressure, left ventricular outflow tract gradients, and global ventricular systolic and diastolic function.
Stress echocardiography can be accomplished using either exercise (treadmill or bicycle) or pharmacologic agents (predominantly dobutamine) as the stress mechanism [1,2]. Echocardiographic contrast agents may be useful in enhancing endocardial border definition when two or more segments of the left ventricle are not well visualized. (See "Contrast echocardiography: Clinical applications" and "Contrast echocardiography: Contrast agents, safety, and imaging technique".)
An overview of the indications, contraindications, techniques, and safety of stress echocardiography will be provided here. Exercise treadmill testing and radionuclide myocardial perfusion imaging, as well as the advantages and disadvantages of stress echocardiography as compared with other stress modalities, are discussed separately. (See "Exercise ECG testing: Performing the test and interpreting the ECG results" and "Exercise radionuclide myocardial perfusion imaging in the diagnosis and prognosis of coronary heart disease" and "Overview of stress radionuclide myocardial perfusion imaging" and "Selecting the optimal cardiac stress test".)
There are several specific indications for stress echocardiography [1,3,4]:
●Evaluation of patients with known or suspected coronary artery disease.
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- STRESS TECHNIQUES
- Exercise two-dimensional echocardiography
- - Protocols
- Bicycle ergometry
- Pharmacologic stress echocardiography
- - Dobutamine stress echocardiography
- Effect of beta blocker therapy
- - Vasodilator stress echocardiography
- Temporary pacing
- Handgrip exercise
- IMAGING TECHNIQUES
- Baseline echocardiography
- Two-dimensional (2D) imaging
- Doppler imaging
- Use of contrast agents
- - Indications for echocontrast
- General concerns
- Safety of dobutamine administration
- Contrast agent safety
- SUMMARY AND RECOMMENDATIONS