STRESS ECHOCARDIOGRAPHY - THE CURRENT STA NDPOINT

Exercise echocardiography, a versatile, noninvasive diagnostic test of left ventricular wall motion performed at rest and under induced stre ss, enables the cardiologist to detect and assess coronary artery dise ase. Stress-induced ischemia is thereby expressed as left ventricular regional wall motion abnormality. By using various physical (bicycle o r treadmill exercise) and pharmacological (dipyridamole, dobutamine, a denosine) stress inducers, the test provides information about the loc alization and extent of coronary artery disease in addition to detecti ng stress-induced coronary insufficiency. As regards diagnostic accura cy in detecting coronary artery disease, stress echocardiography is su perior to exercise electrocardiography and, according to the available data, it is comparable to perfusion scintigraphic testing. Studies ha ve demonstrated the clinical value of stress echocardiography in detec ting residual stenosis after angioplasty, for diagnosing bypass dysfun ction after heart surgery, for preoperative risk assessment in noncard iac surgeries, and for obtaining prognostic information, e.g., after m yocardial infarction. Preliminary studies have shown that pharmacologi cal exercise echocardiography is able to identify viable myocardium in the early phases after acute myocardial infarction. Furthermore, it i s able to predict the functional success of revascularization in chron ic regional left ventricular dysfunction. In addition to the wide rang e of diagnostic possibilities in coronary artery disease, other notabl e applications include stress testing for assessment of global left ve ntricular pump function in patients with aortic regurgitation or cardi omyopathy.