STRESS ECHOCARDIOGRAPHY IN SPECIAL GROUPS - IN WOMEN, IN LEFT-BUNDLE-BRANCH BLOCK, IN HYPERTENSION AND AFTER HEART-TRANSPLANTATION

The non-invasive diagnosis of coronary artery disease by exercise elec trocardiography is less accurate in women than in men, with a high rat e of false-positive results in women. In contrast, recent studies have demonstrated that stress echocardiography in women is more accurate t han exercise echocardiography and that the significantly higher specif icity of stress electrocardiography may have the benefit of avoiding u nnecessary angiography in women. Exercise-induced changes in the elect rocardiogram are nondiagnostic in the presence of left bundle branch b lock or basal ST changes. In these patients, stress echocardiography c an be used instead of conventional scintigraphy for the detection of c oronary artery disease, but further echocardiographic studies are need ed to confirm the promising results. Exercise electrocardiography and exercise echocardiography have been reported to be disappointing in th e early detection of cardiac allograft vasculopathy after heart transp lantation, and dobutamine stress echocardiography overestimates the in cidence of angiographic evidence of cardiac allograft vasculopathy. Ho wever, compared to intravascular ultrasound imaging, dobutamine stress echocardiography seems to be a suitable non-invasive method for detec ting cardiac allograft vasculopathy.