Risk stratification by stress echocardiography

Risk stratification is becoming increasingly important in the evaluation of patients with coronary artery disease. It helps the clinician to optimise the therapeutic choice for each individual. Stress echo cardiography has be en validated for this assessment and provides a lot of prognostic informati on. In patients with suspected coronary artery disease or with stable coronary artery disease, negative stress echocardiography (exercise or pharmacologic al) has been shown to carry a good prognosis for up to 5 years. Extension o f ischaemia seems to carry a poor prognosis. In unstable angina, recent dat a suggest that, after stabilisation with treatment and in the absence of si gnificant ECG or biological changes, dobutamine echocardiography can be per formed with good negative predictive values at 1 year. These results requir e further confirmation and could help provide rapid risk stratification in these patients. In the post-infarct period, stress echo is useful for assessing residual vi ability, the prognostic value of which remains uncertain and multivessel di sease which is associated with a high risk of ischaemic events after infarc tion. In patients with chronic, ischaemic left ventricular dysfunction, dobutamin e stress echocardiography may detect contractile reserve which is associate d with improved IV function and survival after revascularisation. Finally, before non-cardiac surgery, dobutamine stress echocardiography ide ntifies patients at low risk of perioperative coronary events, so helping r isk stratification of patients difficult to assess on clinical examination alone. Stress echo cardiography is an increasingly useful investigation for assess ing the risk of ischaemic events in many everyday situations.