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European Heart Journal. Cardiovascular... Nov 2016A unique and highly versatile technique, stress echocardiography (SE) is increasingly recognized for its utility in the evaluation of non-ischaemic heart disease. SE... (Review)
Review
The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography.
A unique and highly versatile technique, stress echocardiography (SE) is increasingly recognized for its utility in the evaluation of non-ischaemic heart disease. SE allows for simultaneous assessment of myocardial function and haemodynamics under physiological or pharmacological conditions. Due to its diagnostic and prognostic value, SE has become widely implemented to assess various conditions other than ischaemic heart disease. It has thus become essential to establish guidance for its applications and performance in the area of non-ischaemic heart disease. This paper summarizes these recommendations.
Topics: American Heart Association; Cardiac Imaging Techniques; Cardiomyopathy, Hypertrophic; Coronary Artery Disease; Echocardiography, Stress; Echocardiography, Three-Dimensional; Europe; Female; Humans; Male; Myocardial Ischemia; Practice Guidelines as Topic; Sensitivity and Specificity; Societies, Medical; United States
PubMed: 27880640
DOI: 10.1093/ehjci/jew190 -
Circulation Jun 2017Optimal management of patients with stable chest pain relies on the prognostic information provided by noninvasive cardiovascular testing, but there are limited data... (Comparative Study)
Comparative Study Randomized Controlled Trial
Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain: Insights From the PROMISE Trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain).
BACKGROUND
Optimal management of patients with stable chest pain relies on the prognostic information provided by noninvasive cardiovascular testing, but there are limited data from randomized trials comparing anatomic with functional testing.
METHODS
In the PROMISE trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain), patients with stable chest pain and intermediate pretest probability for obstructive coronary artery disease (CAD) were randomly assigned to functional testing (exercise electrocardiography, nuclear stress, or stress echocardiography) or coronary computed tomography angiography (CTA). Site-based diagnostic test reports were classified as normal or mildly, moderately, or severely abnormal. The primary end point was death, myocardial infarction, or unstable angina hospitalizations over a median follow-up of 26.1 months.
RESULTS
Both the prevalence of normal test results and incidence rate of events in these patients were significantly lower among 4500 patients randomly assigned to CTA in comparison with 4602 patients randomly assigned to functional testing (33.4% versus 78.0%, and 0.9% versus 2.1%, respectively; both <0.001). In CTA, 54.0% of events (n=74/137) occurred in patients with nonobstructive CAD (1%-69% stenosis). Prevalence of obstructive CAD and myocardial ischemia was low (11.9% versus 12.7%, respectively), with both findings having similar prognostic value (hazard ratio, 3.74; 95% confidence interval [CI], 2.60-5.39; and 3.47; 95% CI, 2.42-4.99). When test findings were stratified as mildly, moderately, or severely abnormal, hazard ratios for events in comparison with normal tests increased proportionally for CTA (2.94, 7.67, 10.13; all <0.001) but not for corresponding functional testing categories (0.94 [=0.87], 2.65 [=0.001], 3.88 [<0.001]). The discriminatory ability of CTA in predicting events was significantly better than functional testing (c-index, 0.72; 95% CI, 0.68-0.76 versus 0.64; 95% CI, 0.59-0.69; =0.04). If 2714 patients with at least an intermediate Framingham Risk Score (>10%) who had a normal functional test were reclassified as being mildly abnormal, the discriminatory capacity improved to 0.69 (95% CI, 0.64-0.74).
CONCLUSIONS
Coronary CTA, by identifying patients at risk because of nonobstructive CAD, provides better prognostic information than functional testing in contemporary patients who have stable chest pain with a low burden of obstructive CAD, myocardial ischemia, and events.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01174550.
Topics: Aged; Chest Pain; Coronary Angiography; Coronary Artery Disease; Echocardiography, Stress; Exercise Test; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prognosis; Prospective Studies; Tomography, X-Ray Computed
PubMed: 28389572
DOI: 10.1161/CIRCULATIONAHA.116.024360 -
JACC. Cardiovascular Imaging Sep 2018
Topics: Chest Pain; Computed Tomography Angiography; Coronary Angiography; Echocardiography, Stress; Humans
PubMed: 29909112
DOI: 10.1016/j.jcmg.2018.04.016 -
Current Cardiology Reports Oct 2022Stress echocardiography is recommended in valvular heart disease when there is a mismatch between resting transthoracic echocardiography findings and symptoms during... (Review)
Review
PURPOSE OF REVIEW
Stress echocardiography is recommended in valvular heart disease when there is a mismatch between resting transthoracic echocardiography findings and symptoms during activities of daily living. We describe the current methodology and the evidence supporting these applications.
RECENT FINDINGS
The comprehensive stress echo assessment includes valve function (gradients and regurgitation), left ventricular global systolic and diastolic function, left atrial volume, pulmonary congestion, pulmonary arterial pressure, and right ventricular function, integrated with blood pressure response with cuff sphygmomanometer, chronotropic reserve with heart rate, and symptoms. Recent guidelines recommend the evaluation of asymptomatic severe or symptomatic non-severe mitral regurgitation or stenosis with exercise stress and suspected low-flow, low-gradient severe aortic stenosis with reduced ejection fraction with low dose (up to 20 mcg, without atropine) dobutamine stress. Prospective, large-scale studies based on a comprehensive protocol (ABCDE +) capturing the multiplicity of clinical phenotypes are needed to support stress echo-driven treatment strategies.
Topics: Activities of Daily Living; Aortic Valve Stenosis; Atropine Derivatives; Dobutamine; Echocardiography, Stress; Heart Valve Diseases; Humans; Mitral Valve Insufficiency; Prospective Studies; Ventricular Function, Left
PubMed: 36040552
DOI: 10.1007/s11886-022-01765-7 -
JACC. Cardiovascular Imaging Jan 2020
Topics: Diastole; Echocardiography, Stress; Exercise Test; Humans; Predictive Value of Tests; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 31918905
DOI: 10.1016/j.jcmg.2019.12.003 -
Australian Family Physician Aug 2013Coronary artery disease (CAD) remains a major health concern and the leading cause of death in Australia. Effective assessment of patients for possible CAD is a common... (Review)
Review
Coronary artery disease (CAD) remains a major health concern and the leading cause of death in Australia. Effective assessment of patients for possible CAD is a common problem in general practice. Non-invasive tests such as myocardial perfusion scans (MPS), exercise stress tests (ESTs) and stress echocardiography (using exercise or dobutamine as the stressor, as appropriate) can provide useful diagnostic and prognostic information. This brief review discusses the role of MPS in the evaluation of CAD.
Topics: Coronary Angiography; Coronary Artery Disease; Echocardiography, Stress; Exercise Test; Humans; Myocardial Perfusion Imaging
PubMed: 23971065
DOI: No ID Found -
Arquivos Brasileiros de Cardiologia Dec 2023
Topics: Humans; Echocardiography, Stress; Blood Pressure; Exercise Test; Echocardiography
PubMed: 38126487
DOI: 10.36660/abc.20230737 -
JACC. Cardiovascular Imaging Oct 2020The purpose of this study was to assess the functional and prognostic correlates of B-lines during stress echocardiography (SE).
OBJECTIVES
The purpose of this study was to assess the functional and prognostic correlates of B-lines during stress echocardiography (SE).
BACKGROUND
B-profile detected by lung ultrasound (LUS) is a sign of pulmonary congestion during SE.
METHODS
The authors prospectively performed transthoracic echocardiography (TTE) and LUS in 2,145 patients referred for exercise (n = 1,012), vasodilator (n = 1,054), or dobutamine (n = 79) SE in 11 certified centers. B-lines were evaluated in a 4-site simplified scan (each site scored from 0: A-lines to 10: white lung for coalescing B-lines). During stress the following were also analyzed: stress-induced new regional wall motion abnormalities in 2 contiguous segments; reduced left ventricular contractile reserve (peak/rest based on force, ≤2.0 for exercise and dobutamine, ≤1.1 for vasodilators); and abnormal coronary flow velocity reserve ≤2.0, assessed by pulsed-wave Doppler sampling in left anterior descending coronary artery and abnormal heart rate reserve (peak/rest heart rate) ≤1.80 for exercise and dobutamine (≤1.22 for vasodilators). All patients completed follow-up.
RESULTS
According to B-lines at peak stress patients were divided into 4 different groups: group I, absence of stress B-lines (score: 0 to 1; n = 1,389; 64.7%); group II, mild B-lines (score: 2 to 4; n = 428; 20%); group III, moderate B-lines (score: 5 to 9; n = 209; 9.7%) and group IV, severe B-lines (score: ≥10; n = 119; 5.4%). During median follow-up of 15.2 months (interquartile range: 12 to 20 months) there were 38 deaths and 28 nonfatal myocardial infarctions in 64 patients. At multivariable analysis, severe stress B-lines (hazard ratio [HR]: 3.544; 95% confidence interval [CI]: 1.466 to 8.687; p = 0.006), abnormal heart rate reserve (HR: 2.276; 95% CI: 1.215 to 4.262; p = 0.010), abnormal coronary flow velocity reserve (HR: 2.178; 95% CI: 1.059 to 4.479; p = 0.034), and age (HR: 1.031; 95% CI: 1.002 to 1.062; p = 0.037) were independent predictors of death and nonfatal myocardial infarction.
CONCLUSIONS
Severe stress B-lines predict death and nonfatal myocardial infarction. (Stress Echo 2020-The International Stress Echo Study [SE2020]; NCT03049995).
Topics: Coronary Vessels; Dobutamine; Echocardiography, Stress; Humans; Lung; Predictive Value of Tests; Prognosis
PubMed: 32682714
DOI: 10.1016/j.jcmg.2020.04.020 -
JACC. Cardiovascular Imaging May 2022
Topics: Artificial Intelligence; Dobutamine; Echocardiography, Stress; Exercise Test; Forecasting; Humans; Predictive Value of Tests; Sensitivity and Specificity
PubMed: 35512949
DOI: 10.1016/j.jcmg.2021.11.010 -
Kardiologia Polska Nov 2019Stress echocardiography is a safe, low‑cost, widely available, radiation‑free versatile imaging modality that is becoming increasingly recognized as a valuable tool... (Review)
Review
Stress echocardiography is a safe, low‑cost, widely available, radiation‑free versatile imaging modality that is becoming increasingly recognized as a valuable tool in the assessment of coronary heart disease. In recent years, there has also been an increasing use of stress echocardiography in the assessment of nonischemic cardiac disease given its unique ability for simultaneous assessment of both functional performance and exercise‑related noninvasive hemodynamic changes, which can help guide treatment and inform about the prognosis of the patients. Today, in the echocardiography laboratory, we can not only detect wall motion abnormalities resulting from coronary artery stenosis, but also detect alterations to the coronary microvessels, left ventricular systolic and diastolic parameters, heart valves, pulmonary circulation, alveolar‑capillary barrier, and right ventricle. The role of stress echo has been well established in several pathologies, such as aortic stenosis and hypertrophic cardiomyopathy; however, other indications, namely the results of diastolic stress testing and pulmonary hypertension, need additional data and research. This paper presents the current evidence for the role of stress testing in mitral regurgitation, aortic stenosis, hypertrophic cardiomyopathy, heart failure with preserved ejection fraction, and pulmonary hypertension.
Topics: Aortic Valve Stenosis; Cardiomyopathy, Hypertrophic; Cardiovascular Diseases; Echocardiography, Stress; Heart Failure; Humans; Hypertension, Pulmonary; Mitral Valve Insufficiency
PubMed: 31647477
DOI: 10.33963/KP.15032