Echocardiography enables evaluation of cardiac function at rest and during dynamic exercise or pharmacologic stress. Exercise two-dimensional imaging is used primarily to detect the presence and extent of coronary artery disease by provoking regional ischemia; addition of exercise Doppler permits evaluation of valvular function, pulmonary artery pressure, and global ventricular systolic and diastolic function.
The two major types of stress echocardiography are exercise (treadmill or bicycle) and pharmacologic (predominantly dobutamine) stress. In 2007 the American Society of Echocardiography (ASE) published recommendations for the performance, interpretation, and application of stress echocardiography . In 2008 the European Association of Echocardiography (EAE) published an expert consensus statement on stress echocardiography . Echocardiographic contrast agents may be useful to enhance wall motion analysis when image acquisition is suboptimal or technically difficult. (See "Contrast echocardiography: Clinical applications" and "Contrast echocardiography: Contrast agents, safety, and imaging technique".)
Protocols for stress echocardiography will be discussed here. Indications, technique, and safety of stress echocardiography, as well as the advantages and disadvantages of stress echocardiography as compared to other stress modalities, are discussed separately. (See "Stress echocardiography: Indications, imaging techniques and safety" and "Stress echocardiography in the diagnosis and prognosis of coronary heart disease", section on 'Stress test options' and "Selecting the optimal cardiac stress test".)
EXERCISE TWO-DIMENSIONAL ECHOCARDIOGRAPHY
Exercise stress is generally preferred to pharmacologic stress for patients who can perform an exercise test . One exception to this recommendation is the evaluation of preoperative risk and myocardial viability for which most of the data have been derived with pharmacologic (largely dobutamine) stress .
Protocols — Symptom-limited exercise according to a standard protocol with either treadmill or bicycle (upright or supine) exercise is recommended. Since suboptimal stress is a primary cause of false-negative studies, an adequate level of stress (generally defined as achievement of at least 85 percent of the patient's age-predicted maximal heart rate and/or a rate-pressure product of at least 20,000) is recommended. (See "Exercise ECG testing: Performing the test and interpreting the ECG results".)