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European Heart Journal. Cardiovascular... Apr 2022Stress echocardiography is widely used to identify obstructive coronary artery disease (CAD). High accuracy is reported in expert hands but is dependent on operator...
AIMS
Stress 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 RESULTS
Participants 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.
CONCLUSION
Stress 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.
Topics: Aged; Chest Pain; Coronary Artery Disease; Dobutamine; Echocardiography, Stress; Exercise Test; Female; Humans; Male
PubMed: 34148078
DOI: 10.1093/ehjci/jeab092 -
Tidsskrift For Den Norske Laegeforening... Feb 2004In stress echocardiography, ischaemia is detected as wall motion abnormalities. The test can be done both with exercise (which is the more sensitive) and pharmacological... (Review)
Review
BACKGROUND
In stress echocardiography, ischaemia is detected as wall motion abnormalities. The test can be done both with exercise (which is the more sensitive) and pharmacological stress (which is more specific).
MATERIAL AND METHODS
The paper gives an overview of the method, of diagnostic and prognostic value as well as indications and contraindications, based on present literature.
RESULTS AND INTERPRETATION
The sensitivity is 80-90%, specificity 75-100%, dependent on the extent and degree of disease. A negative test predicts a low cardiac event rate of about 1% per year and a low preoperative cardiac risk. The diagnostic accuracy is dependent on optimal equipment quality and on the experience of the examiner. Without specific training, sensitivity is about the same as with exercise ECG. The complication rate is low, dependent on the type of stress. Stress echocardiography is useful in patients unable to exercise, in preoperative risk assessment and in suspected false-negative exercise ECG. In addition it is a supplement to coronary angiography for evaluation of the significance of intermediate stenoses, to identify culprit lesion and for viability detection. Finally, it is useful in aortic stenosis with reduced left ventricular function for evaluation of stenosis and contractile reserve.
Topics: Contraindications; Coronary Disease; Echocardiography, Stress; Humans; Myocardial Ischemia; Predictive Value of Tests; Prognosis; Sensitivity and Specificity
PubMed: 14963508
DOI: No ID Found -
JACC. Cardiovascular Imaging Jan 2020Diastolic dysfunction is a key factor in the pathogenesis of heart failure. Around 50% of cases of heart failure, the hemodynamic correlate of which is increased left... (Review)
Review
Diastolic dysfunction is a key factor in the pathogenesis of heart failure. Around 50% of cases of heart failure, the hemodynamic correlate of which is increased left ventricular filling pressure, are caused by diastolic dysfunction in the setting of apparently normal systolic function. Due to its high prevalence, diastolic dysfunction is often recognized as an incidental finding. Many patients have Doppler echocardiographic evidence of impaired diastolic function but do not have any symptoms of heart failure at rest. In many of these patients, symptoms of diastolic dysfunction occur only during exercise, as left ventricular filling pressure is normal at rest, but increases with exercise. This implies that filling pressures should also be measured during exercise. The diastolic stress test refers to the evaluation of diastolic function, either invasively or noninvasively, during exercise. This review focuses on the clinical need for diastolic stress testing, both invasively and noninvasively.
Topics: Cardiac Catheterization; Diastole; Echocardiography, Doppler; Echocardiography, Stress; Exercise Test; Heart Failure; Humans; Predictive Value of Tests; Ventricular Dysfunction, Left; Ventricular Function, Left; Ventricular Pressure
PubMed: 31202741
DOI: 10.1016/j.jcmg.2019.01.037 -
Tidsskrift For Den Norske Laegeforening... Oct 2012Stress-related symptoms are often the reason that patients with cardiac disease are referred for echocardiographic assessment. We present a method for echocardiographic... (Review)
Review
BACKGROUND
Stress-related symptoms are often the reason that patients with cardiac disease are referred for echocardiographic assessment. We present a method for echocardiographic assessment with concurrent physiological stress where the patient is tested on a semi-supine bicycle, in a half-sitting, tilted position.
MATERIAL AND METHOD
The paper is based on a literature search of PubMed and own experience of the method.
RESULTS
Ergometric stress echocardiography can be used for a number of cardiac conditions where an assessment of cardiac and haemodynamic response to physiological stress is wanted. Evaluation and follow-up of patients with hypertrophic cardiomyopathy, coarctation/recoarctation, mitral and aortic valve disorders have hitherto been the most important groups. The method can also provide important information about pulmonary hypertension and congenital heart defects.
INTERPRETATION
Ergometric stress echocardiography is a non-invasive method with little risk. It is a test that is relatively simple to conduct, and an important supplement to invasive methods.
Topics: Cardiomyopathy, Hypertrophic; Echocardiography, Doppler; Echocardiography, Stress; Exercise Test; Heart Defects, Congenital; Heart Diseases; Heart Valve Diseases; Humans; Hypertension, Pulmonary; Risk Factors; Supine Position
PubMed: 23076486
DOI: 10.4045/tidsskr.11.1538 -
Heart (British Cardiac Society) May 2018Valve stress echocardiography (VSE) can be performed as exercise stress echocardiography (ESE) or dobutamine stress echocardiography (DSE) depending on the patient's... (Review)
Review
Valve stress echocardiography (VSE) can be performed as exercise stress echocardiography (ESE) or dobutamine stress echocardiography (DSE) depending on the patient's clinical status, severity and type of valve disease. ESE combines exercise testing with two-dimensional grey scale and Doppler echocardiography during exercise. Thus, it provides objective assessment of symptomatic status (exercise test), as well as exercise-induced changes of a series of echocardiographic parameters (different depending on the valve disease type), which yield prognostic information in individual patients and help in a better treatment planning. DSE is useful in symptomatic patients with low-gradient aortic stenosis. It clarifies its severity and helps in assessing surgical risk in patients with severe disease and systolic dysfunction. It can be also used to test valve haemodynamics in asymptomatic patients with significant mitral stenosis unable to perform an exercise test or to test the left ventricle response, namely to test viability, in patients with ischaemic secondary mitral regurgitation. VSE has taught us that history taking, clinical examination and resting echocardiography give an 'incomplete picture' of the disease in patients presenting with a severe valve disease. Therefore, its use should be encouraged in such patients.
Topics: Echocardiography, Stress; Heart Valve Diseases; Humans; Patient Care Planning; Prognosis; Reproducibility of Results; Risk Adjustment; Severity of Illness Index
PubMed: 29217633
DOI: 10.1136/heartjnl-2017-311682 -
Progress in Cardiovascular Diseases 2017Mitral regurgitation (MR) is the second most common valvular heart disease referred for corrective surgery. Diagnostic and management dilemmas are not uncommon when... (Review)
Review
Mitral regurgitation (MR) is the second most common valvular heart disease referred for corrective surgery. Diagnostic and management dilemmas are not uncommon when dealing with MR patients. Exercise testing plays an important role in sorting out some of these clinical challenges. In primary asymptomatic MR, exercise testing allows symptom assessment, confident link of symptoms to valve disease severity, safe deferral of surgery for the next 1-year in patients with preserved exercise capacity, insights into the mechanism of exercise-induced dyspnea and helps in individual risk stratification. Moreover, exercise testing in the form of exercise stress echocardiography is also useful in the evaluation of patients with secondary ischemic MR for risk stratification as well as for the detection of patients with moderate ischemic MR in whom mitral valve repair at the time of surgical revascularization may add benefit.
Topics: Clinical Decision-Making; Echocardiography, Stress; Exercise Test; Exercise Tolerance; Health Status; Hemodynamics; Humans; Mitral Valve; Mitral Valve Insufficiency; Predictive Value of Tests; Prognosis; Risk Factors; Severity of Illness Index
PubMed: 29128571
DOI: 10.1016/j.pcad.2017.10.004 -
Circulation. Cardiovascular Imaging Sep 2018
Topics: Echocardiography; Echocardiography, Stress; Exercise Test; Hemodynamic Monitoring; Humans; Mitral Valve Insufficiency
PubMed: 30354671
DOI: 10.1161/CIRCIMAGING.118.008263 -
Cardiovascular Ultrasound Mar 2017Stress echocardiography is an established technique for the assessment of extent and severity of coronary artery disease. The combination of echocardiography with a... (Review)
Review
Stress echocardiography is an established technique for the assessment of extent and severity of coronary artery disease. The combination of echocardiography with a physical, pharmacological or electrical stress allows to detect myocardial ischemia with an excellent accuracy. A transient worsening of regional function during stress is the hallmark of inducible ischemia. Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging or magnetic resonance, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician.The evidence on its clinical impact has been collected over 35 years, based on solid experimental, pathophysiological, technological and clinical foundations. There is the need to implement the combination of wall motion and coronary flow reserve, assessed in the left anterior descending artery, into a single test. The improvement of technology and in imaging quality will make this approach more and more feasible. The future issues in stress echo will be the possibility of obtaining quantitative information translating the current qualitative assessment of regional wall motion into a number. The next challenge for stress echocardiography is to overcome its main weaknesses: dependance on operator expertise, the lack of outcome data (a widesperad problem in clinical imaging) to document the improvement of patient outcomes. This paper summarizes the main indications for the clinical applications of stress echocardiography to ischemic heart disease.
Topics: Echocardiography, Stress; Humans; Myocardial Ischemia; Sensitivity and Specificity
PubMed: 28327159
DOI: 10.1186/s12947-017-0099-2 -
Sao Paulo Medical Journal = Revista... 2021The mechanism of exercise limitation in idiopathic pulmonary arterial hypertension (IPAH) is not fully understood. The role of hemodynamic alterations is well...
BACKGROUND
The mechanism of exercise limitation in idiopathic pulmonary arterial hypertension (IPAH) is not fully understood. The role of hemodynamic alterations is well recognized, but mechanical, ventilatory and gasometric factors may also contribute to reduction of exercise capacity in these individuals.
OBJECTIVE
To investigate whether there is an association between ventilatory pattern and stress Doppler echocardiography (SDE) variables in IPAH patients.
DESIGN AND SETTING
Single-center prospective study conducted in a Brazilian university hospital.
METHODS
We included 14 stable IPAH patients and 14 age and sex-matched controls. Volumetric capnography (VCap), spirometry, six-minute walk test and SDE were performed on both the patients and the control subjects. Arterial blood gases were collected only from the patients. The IPAH patients and control subjects were compared with regard to the abovementioned variables.
RESULTS
The mean age of the patients was 38.4 years, and 78.6% were women. The patients showed hypocapnia, and in spirometry 42.9% presented forced vital capacity (FVC) below the lower limit of normality. In VCap, IPAH patients had higher respiratory rates (RR) and lower elimination of CO2 in each breath. There was a significant correlation between reduced FVC and the magnitude of increases in tricuspid regurgitation velocity (TRV). In IPAH patients, VCap showed similar tidal volumes and a higher RR, which at least partially explained the hypocapnia.
CONCLUSIONS
The patients with IPAH showed hypocapnia, probably related to their higher respiratory rate with preserved tidal volumes; FVC was reduced and this reduction was positively correlated with cardiac output.
Topics: Adult; Cross-Sectional Studies; Echocardiography, Stress; Exercise Test; Familial Primary Pulmonary Hypertension; Female; Humans; Lung; Prospective Studies; Pulmonary Arterial Hypertension
PubMed: 34378739
DOI: 10.1590/1516-3180.2021.0045.R1.0604221 -
JACC. Cardiovascular Imaging Nov 2017Over the last 25 years, patients with hypertrophic cardiomyopathy (HCM) have been studied with a variety of methods employing physiological exercise that have made... (Review)
Review
Over the last 25 years, patients with hypertrophic cardiomyopathy (HCM) have been studied with a variety of methods employing physiological exercise that have made major contributions to disease management and are performed without increased risk. Previously under-utilized in HCM, exercise (stress) echocardiography has become incorporated into the standard clinical assessment and diagnostic armamentarium of HCM using upright or supine symptom-limited treadmill or bicycle modalities. In patients without outflow gradients at rest, exercise echocardiography is the most appropriate method for provoking obstruction, with the capability of predicting future development of progressive heart failure symptoms, and differentiating patients with provocable obstruction from those without obstruction, with major implications for dictating treatment options, that is, surgical myectomy (alternatively, alcohol septal ablation) versus heart transplant. Reduced myocardial oxygen consumption with metabolic (cardiopulmonary) exercise testing provides an independent and quantitative assessment of functional limitation for individual patients when the personal history is ambiguous, and also guides eligibility for heart transplant. Hypotensive blood pressure response to exercise can be an arbitrator in risk stratification decisions. Exercise testing with a variety of methods has become an integral and powerful component of the noninvasive evaluation of HCM, and in some patients can determine treatment strategy.
Topics: Adult; Aged; Blood Pressure; Cardiomyopathy, Hypertrophic; Echocardiography, Stress; Exercise Test; Exercise Tolerance; Female; Health Status; Hemodynamics; Humans; Male; Middle Aged; Oxygen Consumption; Predictive Value of Tests; Prognosis; Risk Factors
PubMed: 29122139
DOI: 10.1016/j.jcmg.2017.07.016