Practical Clinical Applications of Echocardiography in Coronary Heart Disease

Stress echocardiographic techniques. An overview

The choice of upright or supine exercise, pharmacological agents, or atrial pacing for the induction of ischemia depends on the goals and the imaging modality. Dynamic stress echocardiography has improved diagnostic accuracy over and above the stress electrocardiogram. Indications include patients with atypical symptoms, prior nondiagnostic stress electrocardiograms, or baseline electrocardiographic abnormalities. Pharmacological agents coupled with echocardiography do well in the high-risk preoperative patient (e.g., abdominal aneurysmectomy) or in those unable to walk due to orthopedic, neurological, or peripheral vascular disease. When there is uncertainty as to the physiological significance of anatomical (angiographic) stenosis, dynamic stress echocardiography in the ambulatory patient or atrial pacing (or beta-agonist pharmacological stressors) in the catheterization laboratory are useful. The accuracy of stress echocardiography for detection of ischemia in the follow-up of interventional procedures or for postmyocardial infarction risk stratification is superior to standard stress electrocardiography alone.