Echocardiography enables dynamic evaluation of cardiac structure and function at rest and during stress provoked by exercise or a pharmacologic agent. Two-dimensional echocardiographic imaging performed during or immediately after stress is used primarily to detect the presence (or absence) and extent of ischemia secondary to obstructive coronary artery disease and to measure or estimate overall ventricular systolic function. In addition, Doppler echocardiographic imaging performed during or after exercise stress allows for evaluation of valvular function, pulmonary artery pressure, and left ventricular diastolic function.
The two major types of stress echocardiography are exercise (treadmill or bicycle) stress echocardiography and pharmacologic (predominantly dobutamine) stress echocardiography. The indications for stress echocardiography, along with the imaging technique and safety of the procedure, will be discussed here. Details of specific stress echocardiography protocols along with the advantages and disadvantages of stress echocardiography as compared to other stress modalities are also discussed separately. (See "Protocols for stress echocardiography" and "Stress echocardiography in the diagnosis and prognosis of coronary heart disease", section on 'Stress test options' and "Selecting the optimal cardiac stress test".)
Stress testing is a common procedure with a variety of indications. Most commonly, however, stress testing is performed to estimate the likelihood of obstructive coronary artery (CAD) in patients who present with symptoms suggesting this diagnosis, or to estimate the ischemic burden and the prognosis in a patient with known CAD. The indications for stress testing are discussed in detail separately. (See "Stress testing for the diagnosis of coronary heart disease", section on 'Indications for diagnostic non-invasive testing' and "Stress testing to determine prognosis and management of patients with known or suspected coronary heart disease".)
There are several specific indications for stress echocardiography as noted in the 2007 American Society of Echocardiography (ASE) stress echocardiography guidelines :