Abstract
Many tests have been proposed in combination with echocardiography, but only a few have a role in clinical practice. For the diagnosis of organic coronary artery disease, exercise remains the paradigm of all stress tests and the first which was combined with stress echocardiography. In the early 1970s, M-mode recordings of the left ventricle were used in normal subjects [1] and in patients with coronary artery disease [2]. Subsequently, two-dimensional (2D) echocardiography was used to document ischemic regional wall motion abnormality during exercise [3]. The technique was at that time so challenging [4] that with the introduction of dipyridamole [5] and dobutamine [6] as pharmacological stressors, many laboratories used pharmacological stress even in patients who were able to exercise. Large-scale, multicenter, effectiveness studies providing outcome data are available only with pharmacological [7, 8] not with exercise echocardiography, offering a more robust evidence-based platform for their use in clinical practice. Exercise echocardiography was only really applied as a clinical tool in the early 1990s [4], and it is now increasingly used for the diagnosis of coronary artery disease, the functional assessment of intermediate stenosis, and risk stratification. A series of successive improvements led to a progressively widespread acceptance: digital echocardiographic techniques, allowing capture and synchronized display of the same view at different stages [9], improved endocardial border detection by harmonic imaging [10], and ultrasound contrast agents that opacify the left ventricle [11]. In the USA, most laboratories use the post-treadmill approach with imaging at rest and as soon as possible during the recovery period [12, 13]. In Europe, a number of centers have implemented their stress echocardiography laboratory with a dedicated bed or table allowing bicycle exercise in a semisupine position and real-time continuous imaging throughout exercise [14, 15]. The diffusion of semisupine exercise imaging – much more user-friendly for the sonographer than the treadmill test – made image acquisition easier and interpretation faster [16–18]. Semisupine exercise gained its well-deserved role in the stress echocardiography laboratory for coronary artery disease diagnosis and, with growing frequency outside coronary artery disease, in the assessment of pulmonary hypertension, valve disease, cardiomyopathy, and heart failure [19, 20].
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References
Kraunz RF, Kennedy JW (1970) An ultrasonic determination of left ventricular wall motion in normal man. Studies at rest and after exercise. Am Heart J 79:36–43
Mason SJ, Weiss JL, Weisfeldt ML et al (1979) Exercise echocardiography in detection of wall motion abnormalities during ischemia. Circulation 59:50–54
Wann LS, Faris JV, Childress RH et al (1979) Exercise cross sectional echocardiography in ischemic heart disease. Circulation 60:1300–1308
Bairey CN, Rozanski A, Berman DS (1988) Exercise echocardiography: ready or not? J Am Coll Cardiol 11:1355–1358
Picano E, Distante A, Masini M et al (1985) Dipyridamole-echocardiography test in effort angina pectoris. Am J Cardiol 56:452–456
Berthe C, Pierard LA, Hiernaux M et al (1986) Predicting the extent and location of coronary artery disease in acute myocardial infarction by echocardiography during dobutamine infusion. Am J Cardiol 58:1167–1172
Picano E, Landi P, Bolognese L et al (1993) Prognostic value of dipyridamole echocardiography early after uncomplicated myocardial infarction: a large-scale, multicenter trial. The EPIC Study Group. Am J Med 95:608–618
Picano E, Sicari R, Landi P et al (1998) Prognostic value of myocardial viability in medically treated patients with global left ventricular dysfunction early after an acute uncomplicated myocardial infarction: a dobutamine stress echocardiographic study. Circulation 98:1078–1084
Feigenbaum H (1994) A digital echocardiographic laboratory. J Am Soc Echocardiogr 7:105–106
Caidahl K, Kazzam E, Lidberg J et al (1998) New concept in echocardiography: harmonic imaging of tissue without use of contrast agent. Lancet 352:1264–1270
Laskar R, Grayburn PA (2000) Assessment of myocardial perfusion with contrast echocardiography at rest and with stress: an emerging technology. Prog Cardiovasc Dis 43:245–258
Armstrong WF, Ryan T (2008) Stress echocardiography from 1979 to present. J Am Soc Echocardiogr 21:22–28
Pellikka PA, Nagueh SF, Elhendy AA et al; American Society of Echocardiography (2007) American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr 20:1021–1041
Pierard LA (2007) Echocardiographic monitoring throughout exercise better than the posttreadmill approach? J Am Coll Cardiol 50:1864–1866
Sicari R, Nihoyannopoulos P, Evangelista A et al (2008) Stress echocardiography consensus statement of the European Association of Echocardiography. Eur J Echocardiogr 9:415–437
Picano E, Lattanzi F, Masini M et al (1987) Comparison of high-dose dipyridamole-echocardiography test and exercise 2-D echocardiography for diagnosis of coronary artery disease. Am J Cardiol 59:539–542
Hecht HS, DeBord L, Sho WR et al (1993) Digital supine bicycle stress echocardiography: a new technique for evaluating coronary artery disease. J Am Coll Cardiol 21:950–956
Park TH, Tayan N, Takeda K et al (2007) Supine bicycle echocardiography improved diagnostic accuracy and physiologic assessment of coronary artery disease with the incorporation of intermediate stages of exercise. J Am Coll Cardiol 50:1857–1863
Piérard LA, Lancellotti P (2007) Stress testing in valve disease. Heart 93:766–772
Tumminello G, Lancellotti P, Lempereur M et al (2007) Determinants of pulmonary artery hypertension at rest and during exercise in patients with heart failure. Eur Heart J 28:569–574
Bombardini T, Gemignani V, Bianchini E et al (2007) Cardiac reflections and natural vibrations: force-frequency relation recording system in the stress echo lab. Cardiovasc Ultrasound 5:42
Bombardini T, Nevola E, Giorgetti A et al (2008) Prognostic value of left-ventricular and peripheral vascular performance in patients with dilated cardiomyopathy. J Nucl Cardiol 15:353–362
Beleslin BD, Ostojic M, Stepanovic J et al (1994) Stress echocardiography in the detection of myocardial ischemia. Head-to-head comparison of exercise, dobutamine, and dipyridamole tests. Circulation 90:1168–1176
Thadani U, West RO, Mathew TM et al (1977) Hemodynamics at rest and during supine and sitting bicycle exercise in patients with coronary artery disease. Am J Cardiol 39:776–783
Poliner LR, Dehmer GJ, Lewis SE et al (1980) Left ventricular performance in normal subjects: a comparison of the responses to exercise in the upright and supine positions. Circulation 62:528–534
Currie PJ, Kelly MJ, Pitt A (1983) Comparison of supine and erect bicycle exercise eletrocardiography in coronary artery disease: accentuation of exercise-induced ischemic ST segment depression by supine posture. Am J Cardiol 52:1167–1173
Yamakado T, Kasai A, Masuda T et al (1996) Exercise-induced coronary spasm: comparison of treadmill and bicycle exercise in patients with vasospastic angina. Coron Artery Dis 7:819–822
Fletcher GF, Balady GJ, Amsterdam EA et al (2001) Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 104:1694–1740
Varga A, Garcia MA, Picano E et al (2006) Safety of stress echocardiography (from the International Stress Echo Complication Registry). Am J Cardiol 98:541–543
Picano E, Marini C, Pirelli S et al (1992) Safety of intravenous high-dose dipyridamole echocardiography. The Echo-Persantine International Cooperative Study Group. Am J Cardiol 70:252–258
Picano E, Mathias W Jr, Pingitore A et al (1994) Safety and tolerability of dobutamine-atropine stress echocardiography: a prospective, multicentre study. Echo Dobutamine International Cooperative Study Group. Lancet 344:1190–1192
Beckmann S, Haug G (1999) National registry 1995–1998 on 150,000 stress echo examinations side effects and complications in 60,448 examinations of the registry 1997–1998. Circulation 100(Suppl):3401A
Fleischmann KE, Hunink MG, Kuntz KM et al (1998) Exercise echocardiography or exercise SPECT imaging? A meta analysis of diagnostic test performance. JAMA 280:913–920
Albuquerque de Fonseca L, Picano E (2001) Comparison of dipyridamole and exercise stress echocardiography for detection of coronary artery disease (a meta-analysis). Am J Cardiol 87:1193–1196
Kim C, Kwok YS, Heagerty P et al (2001) Pharmacologic stress testing for coronary disease diagnosis: a meta-analysis. Am Heart J 142:934–944
Noguchi Y, Nagata-Kobayashi S, Stahl JE et al (2005) A meta-analytic comparison of echocardiographic stressors. Int J Cardiovasc Imaging 21:189–207
Heijenbrok-Kal MH, Fleischmann KE, Hunink MG (2007) Stress echocardiography, stress single-photon-emission computed tomography and electron beam computed tomography for the assessment of coronary artery disease: a meta-analysis of diagnostic performance. Am Heart J 154:415–423
Hoffer EP, Dewe W, Celentano C et al (1999) Low-level exercise echocardiography detects contractile reserve and predicts reversible dysfunction after acute myocardial infarction: comparison with low-dose dobutamine echocardiography. J Am Coll Cardiol 34:989–997
Lancellotti P, Hoffer EP, Piérard LA (2003) Detection and clinical usefulness of a biphasic response during exercise echocardiography early after myocardial infarction. J Am Coll Cardiol 41:1142–1147
Sawada SG, Ryan T, Conley M et al (1990) Prognostic value of a normal exercise echocardiogram. Am Heart J 120:49–55
Olmos LI, Dakik H, Gordon R et al (1998) Long-term prognostic value of exercise echocardiography compared with exercise 201Tl, ECG, and clinical variables in patients evaluated for coronary artery disease. Circulation 98:2679–2686
Marwick TH, Case C, Vasey C et al (2001) Prediction of mortality by exercise echocardiography: a strategy for combination with the Duke treadmill score. Circulation 103:2566–2571
Arruda-Olson AM, Juracan EM, Mahoney DW et al (2002) Prognostic value of exercise echocardiography in 5,798 patients: is there a gender difference? J Am Coll Cardiol 39:625–631
Jaarsma W, Visser C, Funke Kupper A (1986) Usefulness of two-dimensional exercise echocardiography shortly after myocardial infarction. Am J Cardiol 57:86–90
Applegate RJ, Dell’Italia LJ, Crawford MH (1987) Usefulness of two-dimensional echocardiography during low level exercise-testing early after uncomplicated myocardial infarction. Am J Cardiol 60:10–14
Ryan T, Armstrong WF, O’Donnel JA et al (1987) Risk stratification following acute myocardial infarction during exercise two-dimensional echocardiography. Am Heart J 114:1305–1316
Quintana M, Lindvall K, Ryden L et al (1995) Prognostic value of predischarge exercise stress echocardiography after acute myocardial infarction. Am J Cardiol 76:1115–1121
Heupler S, Mehta R, Lobo A et al (1997) Prognostic implications of exercise echocardiography in women with known or suspected coronary artery disease. J Am Coll Cardiol 30:414–420
Marwick TH, Case C, Sawada S et al (2002) Prediction of outcomes in hypertensive patients with suspected coronary disease. Hypertension 39:1113–1138
Shaw LJ, Marwick TH, Berman DS et al (2006) Incremental cost-effectiveness of exercise echocardiography vs. SPECT imaging for the evaluation of stable chest pain. Eur Heart J 27:2448–2458
Yao SS, Shah A, Bangalore S et al (2007) Transient ischemic left ventricular cavity dilation is a significant predictor of severe and extensive coronary artery disease and adverse outcome in patients undergoing stress echocardiography. J Am Soc Echocardiogr 20:352–358
Lancellotti P, Gérard PL, Piérard LA (2006) Long-term outcome of patients with heart failure and dynamic functional mitral regurgitation. Eur Heart J 27:187–192
Peteiro JC, Monserrat L, Bouzas A et al (2006) Risk stratification by treadmill exercise echocardiography. J Am Soc Echocardiogr 19:894–901
Picano E, Pellikka PA (2014) Stress echo applications beyond coronary artery disease. Eur Heart J 35:1033–1040
Henri C, Pierard L, Lancellotti P et al (2014) Exercise testing stress imaging in valvular heart disease. Can J Cardiol 30:1012–1016
Montalescot G, Sechtem U, Achenbach S et al (2013) 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 34:2949–3003
Wolk MJ, Bailey SR, Doherty JU et al; American College of Cardiology Foundation Appropriate Use Criteria Task Force (2014) ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol 63:380–406
Picano E, Vañó E, Rehani MM et al (2014) The appropriate and justified use of medical radiation in cardiovascular imaging: a position document of the ESC Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and Electrophysiology. Eur Heart J 35:665–672
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See also in the section illustrative cases: case number 9 (by Jesus Peteiro, La Coruna, Spain) and 10 (by Bogdan Popescu, MD, Bucarest, Romania); cases 29, 30, and 31 (by Maria Joao Andrade, Lisbon, Portugal)
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Piérard, L.A., Picano, E. (2015). Exercise Echocardiography. In: Stress Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-319-20958-6_11
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DOI: https://doi.org/10.1007/978-3-319-20958-6_11
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