[Stress echocardiography: development and significance].
Exercise electrocardiography is still the primary method used in the non-invasive assessment of coronary artery disease. Stress echocardiography is now being increasingly used as a more sensitive adjunct technique to assess ischemia. Ischemia provoked by stress can induce reversible wall motion abnormalities which are disclosed by cross-sectional 2-dimensional echocardiography and standard projections. The types of stress used are physical exercise (bicycle, treadmill), atrial pacing or pharmacologic stimulation. In the latter, the catecholamine dobutamine has emerged as preferable to the vasodilators dipyridamole and adenosine. The diagnostic accuracy of dobutamine stress echocardiography is comparable to that of bicycle or treadmill exercise echocardiography, but dobutamine stress echocardiography is technically simpler and can be performed in patients unable to exercise. Its sensitivity in diagnosing ischemic or viable myocardium is comparable to that of nuclear methods, MRI or PET. In contrast to nuclear methods, stress echocardiography is however free of radiation. In the assessment of patients with coronary artery disease, stress echocardiography has been shown to be valuable for diagnosis, preoperative risk stratification and determination of prognosis. Furthermore, low dose dobutamine echocardiography can be used to detect viable myocardium. Despite these very promising aspects of the method, there are recognized disadvantages and limitations: stress echocardiography is very time-consuming and operator-dependent; its sensitivity correlates strongly with the number of studies performed; analysis of wall motion is performed qualitatively on a purely subjective level, and hence lacks the objectivity of a quantitative approach. These factors emphasize the need for intensive research to render stress echocardiographic analysis more objective. Automatic boundary detection of left ventricular endocardium, color-Doppler-based tissue imaging and three-dimensional reconstruction offer interesting perspectives in rendering the subjective more objective.
Attenhofer
C
C
Abteilung Kardiologie, Universitätsspital Zürich.
Ritter
M
M
Jenni
R
R
D000241:Adenosine; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D004176:Dipyridamole; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test; D006321:Heart / Q000187:drug effects; D006801:Humans; D012680:Sensitivity and Specificity
D004280:Dobutamine; D004176:Dipyridamole; D000241:Adenosine
Stress-Echokardiographie: Entwicklung und Bedeutung.