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Special Subsets of Clinically Defined Patients: Elderly, Women, Outpatients, Chest Pain Unit, Noncardiac Surgery, Cancer

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Stress Echocardiography

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Abstract

Individuals over 65 years of age account for 12 % of the total population in the USA, twice the proportion 20 years ago. This group is expected to increase by 20 % in the next decade and is predicted to constitute more than 20 % of the population by the year 2030. Moreover, the proportion of individuals aged 80 and over in EU Member States currently represents 4.7 % of the total population and is projected to increase to 12.1 % in 2060 [1]. As the prevalence and severity of coronary artery disease (CAD) show a striking growth with age [2, 3], the assessment of risk in elderly and very old (>80 years) is and will be increasingly important in the next future. Unfortunately, in these patients, the predictive value of a test may be negatively affected by reduced life expectancy. On the other hand, due to the high prevalence of CAD in this subset, a negative test result may likely be a false-negative one [3]. Exercise electrocardiography shows limited feasibility in very old patients, mainly due to neuromuscular weakness; physical deconditioning; or neurologic, orthopedic, peripheral vascular, or respiratory limitations. In addition, test specificity declines as age increases [3] because of repolarization abnormalities on resting electrocardiogram due to hypertension [4], left ventricular hypertrophy [4, 5], or digoxin intake [6]. Stress echocardiography has been found to confer effective prognostic contribution in elderly individuals [7–16]. Pharmacologic stress echocardiography provides useful prognostic information in patients >65 years of age. However, its prognostic value decreases with increasing age [12] (Fig. 29.1). In particular, ischemia failed to add prognostic information in subjects >80 years of age, and in this subset it does not predict mortality [16] (Fig. 29.2). The stratification strategy should be tailored and designed on patients’ profile. In patients older than 80 years, stress echocardiography does not provide additive information on outcome. Elderly patients with positive stress echocardiography test results tended to receive less coronary angiography and fewer revascularization procedures when compared to the overall population [7]. Advanced age often directs physician’s decision on therapeutic strategy, but this policy in time may adversely affect outcome, since a dramatic change in the natural history can be achieved by properly targeted interventions oriented by physiologic testing results. With current advances in surgical techniques and intraoperative myocardial protection, elderly patients with multivessel disease and even significant baseline dysfunction can undergo coronary artery bypass surgery with a low in-hospital mortality rate and an excellent short-term survival rate. Stress echocardiography is a suitable and effective tool for risk stratification in this setting.

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References

  1. Davis D, Brayne C (2015) Ageing, health, and social care. Lancet 385:1699–1700

    Google Scholar 

  2. Roger VL, Go AS, Lloyd-Jones DM, American Heart Association Statistics Committee and Stroke Statistics Subcommittee et al (2012) Heart disease and stroke statistics–2012 update: a report from the American Heart Association. Circulation 125:e2–e220

    Article  PubMed Central  PubMed  Google Scholar 

  3. Task Force Members, 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

    Article  Google Scholar 

  4. Scheler S, Motz W, Strauer BE (1994) Mechanism of angina pectoris in patients with systemic hypertension and normal epicardial coronary arteries by arteriogram. Am J Cardiol 73:478–482

    Article  CAS  PubMed  Google Scholar 

  5. Wroblewski EM, Pearl FJ, Hammer WJ, Bove AA (1982) False positive stress tests due to undetected left ventricular hypertrophy. Am J Epidemiol 115:412–417

    CAS  PubMed  Google Scholar 

  6. Meyers DG, Bendon KA, Hankins JH, Stratbucker RA (1990) The effect of baseline electrocardiographic abnormalities on the diagnostic accuracy of exercise-induced ST segment changes. Am Heart J 119:272–276

    Article  CAS  PubMed  Google Scholar 

  7. Camerieri A, Picano E, Landi P et al (1993) Prognostic value of dipyridamole echocardiography early after myocardial infarction in elderly patients. J Am Coll Cardiol 22:1809–1815

    Article  CAS  PubMed  Google Scholar 

  8. Poldermans D, Fioretti PM, Boersma E et al (1994) Dobutamine-atropine stress echocardiography in elderly patients unable to perform an exercise test. Hemodynamic characteristics, safety, and prognostic value. Arch Intern Med 154:2681–2686

    Article  CAS  PubMed  Google Scholar 

  9. Anthoupolus LP, Bonou MS, Kardaras FG et al (1996) Stress echocardiography in elderly patients with coronary artery disease. Applicability, safety and prognostic value of dobutamine and adenosine echocardiography in elderly patients. J Am Coll Cardiol 28:52–59

    Article  Google Scholar 

  10. Arruda AM, Das MK, Roger VL, Klarich KW, Mahoney DW, Pellikka PA (2001) Prognostic value of exercise echocardiography in 2,632 patients >65 years of age. J Am Coll Cardiol 37:1036–1041

    Article  CAS  PubMed  Google Scholar 

  11. Biagini E, Elhendy A, Schinkel AF et al (2005) Long-term prediction of mortality in elderly persons by dobutamine stress echocardiography. J Gerontol A Biol Sci Med Sci 60:1333–1338

    Article  PubMed  Google Scholar 

  12. Cortigiani L, Bigi R, Sicari R, Landi P, Bovenzi F, Picano E (2007) Prognostic implication of dipyridamole or dobutamine stress echocardiography for evaluation of patients >65 years of age with known or suspected coronary artery disease. Am J Cardiol 99:1491–1495

    Article  PubMed  Google Scholar 

  13. Chaudhry FA, Qureshi EA, Yao SS, Bangalore S (2007) Risk stratification and prognosis in octogenarians undergoing stress echocardiographic study. Echocardiography 24:851–859

    Article  PubMed  Google Scholar 

  14. Innocenti F, Totti A, Baroncini C, Fattirolli F, Burgisser C, Pini R (2011) Prognostic value of dobutamine stress echocardiography in octogenarians. Int J Cardiovasc Imaging 27:65–74

    Article  PubMed  Google Scholar 

  15. Bernheim AM, Kittipovanonth M, Takahashi PY, Gharacholou SM, Scott CG, Pellikka PA (2011) Does the prognostic value of dobutamine stress echocardiography differ among different age groups? Am Heart J 161:740–745

    Article  PubMed  Google Scholar 

  16. Cortigiani L, Bigi R, Bovenzi F, Picano E, Sicari R (2013) Stress echocardiography for risk assessment in octogenarians. Int J Cardiol 167:2356–2358

    Article  PubMed  Google Scholar 

  17. Masini M, Picano E, Lattanzi F, Distante A, L’Abbate A (1988) High-dose dipyridamole echocardiography test in women: correlation with exercise-electrocardiography test and coronary arteriography. J Am Coll Cardiol 12:682–685

    Article  CAS  PubMed  Google Scholar 

  18. Marwick TH, Anderson T, Williams MJ et al (1995) Exercise echocardiography is an accurate and cost-efficient technique for detection of coronary artery disease in women. J Am Coll Cardiol 26:335–341

    Article  CAS  PubMed  Google Scholar 

  19. Elhendy A, van Domburg RT, Bax JJ et al (1998) Noninvasive diagnosis of coronary artery stenosis in women with limited exercise capacity: comparison of dobutamine stress echocardiography and 99mTc sestamibi single-photon emission CT. Chest 114:1097–1104

    Article  CAS  PubMed  Google Scholar 

  20. Cortigiani L, Sicari R, Bigi R, Landi P, Bovenzi F, Picano E (2009) Impact of gender on risk stratification by stress echocardiography. Am J Med 122:301–309

    Article  PubMed  Google Scholar 

  21. Cortigiani L, Dodi C, Paolini EA, Bernardi D, Bruno G, Nannini E (1998) Prognostic value of pharmacological stress echocardiography in women with chest pain and unknown coronary artery disease. J Am Coll Cardiol 32:1975–1981

    Article  CAS  PubMed  Google Scholar 

  22. Dodi C, Cortigiani L, Masini M, Olivotto I, Azzarelli A, Nannini E (2001) The incremental prognostic value of stress echo over exercise electrocardiography in women with chest pain of unknown origin. Eur Heart J 22:145–152

    Article  CAS  PubMed  Google Scholar 

  23. Cortigiani L, Gigli G, Vallebona A et al (2001) The stress echo prognostic gender gap. Eur J Echocardiogr 2:132–138

    Article  CAS  PubMed  Google Scholar 

  24. Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2 (2006) www.nap.edu/books/030909156X/html

  25. 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

    Article  PubMed  Google Scholar 

  26. Miller TD, Roger VL, Hodge DO, Gibbons RJ (2005) A simple clinical score accurately predicts outcome in a community-based population undergoing stress testing. Am J Med 118:866–872

    Article  PubMed  Google Scholar 

  27. Grunig E, Mereles D, Benz A et al (2002) Contribution of stress echocardiography to clinical decision making in unselected ambulatory patients with known or suspected coronary artery disease. Int J Cardiol 84:179–185

    Article  PubMed  Google Scholar 

  28. Gordon BM, Mohan V, Chapekis AT et al (1995) An analysis of the safety of performing dobutamine stress echocardiography in an ambulatory setting. J Am Soc Echocardiogr 8:15–20

    Article  CAS  PubMed  Google Scholar 

  29. Cortigiani L, Lombardi M, Landi P et al (1998) Risk stratification by pharmacological stress echocardiography in a primary care cardiology centre. Experience in 1082 patients. Eur Heart J 19:1673–1680

    Article  CAS  PubMed  Google Scholar 

  30. Cortigiani L, Picano E, Coletta C, On behalf of Echo Persantine International Cooperative (EPIC) Study Group, Echo Dobutamine International Cooperative (EDIC) Study Group et al (2001) Safety, feasibility, and prognostic implications of pharmacologic stress echocardiography in 1482 patients evaluated in an ambulatory setting. Am Heart J 141:621–629

    Article  CAS  PubMed  Google Scholar 

  31. Stein RA, Chaitman BR, Balady GJ et al (2000) Safety and utility of exercise testing in emergency room chest pain centers: an advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association. Circulation 102:1463–1467

    Article  CAS  PubMed  Google Scholar 

  32. Mather PJ, Shah R (2001) Echocardiography, nuclear scintigraphy, and stress testing in the emergency department evaluation of acute coronary syndrome. Emerg Med Clin North Am 19:339–349

    Article  CAS  PubMed  Google Scholar 

  33. Shah BN, Balaji G, Alhajiri A et al (2013) Incremental diagnostic and prognostic value of contemporary stress echocardiography in a chest pain unit: mortality and morbidity outcomes from a real-world setting. Circ Cardiovasc Imaging 6:202–209

    Article  PubMed  Google Scholar 

  34. Trippi JA, Lee KS, Kopp G et al (1997) Dobutamine stress tele-echocardiography for evaluation of emergency department patients with chest pain. J Am Coll Cardiol 30:627–632

    Article  CAS  PubMed  Google Scholar 

  35. Colon PJ 3rd, Cheirif J (1999) Long-term value of stress echocardiography in the triage of patients with atypical chest pain presenting to the emergency department. Echocardiography 16:171–177

    Article  PubMed  Google Scholar 

  36. Geleijnse ML, Elhendy A, Kasprzak JD et al (2000) Safety and prognostic value of early dobutamine-atropine stress echocardiography in patients with spontaneous chest pain and a non-diagnostic electrocardiogram. Eur Heart J 21:397–406

    Article  CAS  PubMed  Google Scholar 

  37. Orlandini A, Tuero E, Paolasso E et al (2000) Usefulness of pharmacologic stress echocardiography in a chest pain center. Am J Cardiol 86:1247–1250

    Article  CAS  PubMed  Google Scholar 

  38. Buchsbaum M, Marshall E, Levine B et al (2001) Emergency department evaluation of chest pain using exercise stress echocardiography. Acad Emerg Med 8:196–199

    Article  CAS  PubMed  Google Scholar 

  39. Bholasingh R, Cornel JH, Kamp O et al (2003) Prognostic value of predischarge dobutamine stress echocardiography in chest pain patients with a negative cardiac troponin T. J Am Coll Cardiol 41:596–602

    Article  PubMed  Google Scholar 

  40. Bedetti G, Pasanisi E, Tintori G et al (2005) Stress echo in chest pain unit: the SPEED trial. Int J Cardiol 102:461–467

    Article  PubMed  Google Scholar 

  41. Conti A, Paladini B, Toccafondi S et al (2005) Effectiveness of a multidisciplinary chest pain unit for the assessment of coronary syndromes and risk stratification in the Florence area. Am Heart J 144:630–635

    Article  Google Scholar 

  42. Innocenti F, Cerabona P, Donnini C et al (2014) Long-term prognostic value of stress echocardiography in patients presenting to the ED with spontaneous chest pain. Am J Emerg Med 32:731–736

    Article  PubMed  Google Scholar 

  43. Hoffmann U, Truong QA, Schoenfeld DA et al (2012) Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med 367:299–308

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  44. Litt HI, Gatsonis C, Snyder B et al (2012) CT angiography for safe discharge of patients with possible acute coronary syndromes. N Engl J Med 366:1393–1403

    Article  CAS  PubMed  Google Scholar 

  45. Redberg R (2012) Coronary CT angiography for acute chest pain. N Engl J Med 367:375–376

    Article  CAS  PubMed  Google Scholar 

  46. American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography; American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society; Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American College of Chest Physicians, Douglas PS, Garcia MJ, Haines DE et al (2011) ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians. J Am Soc Echocardiogr 24:229–267

    Article  Google Scholar 

  47. Qaseem A, Alguire P, Dallas P et al (2012) Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care. Ann Intern Med 156:147–149

    Article  PubMed  Google Scholar 

  48. Picano E, Pasanisi E, Brown J et al (2007) A gatekeeper for the gatekeeper: inappropriate referrals to stress echocardiography. Am Heart J 154:285–290

    Article  PubMed  Google Scholar 

  49. Gibbons RJ, Miller TD, Hodge D et al (2008) Application of appropriateness criteria to stress single-photon emission computed tomography sestamibi studies and stress echocardiograms in an academic medical center. J Am Coll Cardiol 51:1283–1289

    Article  PubMed  Google Scholar 

  50. Mansour IN, Lang RM, Aburuwaida WM, Bhave NM, Ward RP (2010) Evaluation of the clinical application of the ACCF/ASE appropriateness criteria for stress echocardiography. J Am Soc Echocardiogr 23:1199–1204

    Article  PubMed  Google Scholar 

  51. Ingkanisorn WP, Kwong RY, Bohme NS et al (2006) Prognosis of negative adenosine stress magnetic resonance in patients presenting to an emergency department with chest pain. J Am Coll Cardiol 47:1427–1432

    Article  PubMed  Google Scholar 

  52. Cury RC, Shash K, Nagurney JT et al (2008) Cardiac magnetic resonance with T2-weighted imaging improves detection of patients with acute coronary syndrome in the emergency department. Circulation 118:837–844

    Article  PubMed  Google Scholar 

  53. Fleisher LA, Fleischmann KE, Auerbach AD et al (2014) 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 64(22):e77–e137. pii: S0735-1097(14)05536-3. doi:10.1016/j.jacc.2014.07.944

  54. Kristensen SD, Knuuti J, Saraste A et al (2014) 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: the Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J 35:2383–2431

    Google Scholar 

  55. Tischler MD, Lee TH, Hirsch AT et al (1991) Prediction of major cardiac events after peripheral vascular surgery using dipyridamole echocardiography. Am J Cardiol 68:593–597

    Article  CAS  PubMed  Google Scholar 

  56. Sicari R, Picano E, Lusa AM et al (1995) The value of dipyridamole echocardiography in risk stratification before vascular surgery. A multicenter study. The EPIC (Echo Persantine International Study) Group-Subproject: risk stratification before major vascular surgery. Eur Heart J 16:842–847

    CAS  PubMed  Google Scholar 

  57. Rossi E, Citterio F, Vescio MF et al (1998) Risk stratification of patients undergoing peripheral vascular revascularization by combined resting and dipyridamole echocardiography. Am J Cardiol 82:306–310

    Article  CAS  PubMed  Google Scholar 

  58. Pasquet A, D’Hondt AM, Verhelst R et al (1998) Comparison of dipyridamole stress echocardiography and perfusion scintigraphy for cardiac risk stratification in vascular surgery patients. Am J Cardiol 82:1468–1474

    Article  CAS  PubMed  Google Scholar 

  59. Sicari R, Ripoli A, Picano E et al on behalf of the EPIC study group (1999) Perioperative prognostic value of dipyridamole echocardiography in vascular surgery: a large-scale multicenter study on 509 patients. Circulation 100(Suppl 19):II269–II274

    Google Scholar 

  60. Zamorano J, Duque A, Baquero M et al (2002) Stress echocardiography in the pre-operative evaluation of patients undergoing major vascular surgery. Are results comparable with dipyridamole versus dobutamine stress echo? Rev Esp Cardiol 55:121–126

    Article  PubMed  Google Scholar 

  61. Lane RT, Sawada SG, Segar DS et al (1991) Dobutamine stress echocardiography for assessment of cardiac risk before noncardiac surgery. Am J Cardiol 68:976–977

    Article  CAS  PubMed  Google Scholar 

  62. Lalka SG, Sawada SG, Dalsing MC et al (1992) Dobutamine stress echocardiography as a predictor of cardiac events associated with aortic surgery. J Vasc Surg 15:831–842

    Article  CAS  PubMed  Google Scholar 

  63. Davila-Roman VG, Waggoner AD, Sicard GA et al (1993) Dobutamine stress echocardiography predicts surgical outcome in patients with an aortic aneurysm and peripheral vascular disease. J Am Coll Cardiol 21:957–963

    Article  CAS  PubMed  Google Scholar 

  64. Eichelberger JP, Schwarz KQ, Black ER et al (1993) Predictive value of dobutamine echocardiography just before noncardiac vascular surgery. Am J Cardiol 72:602–607

    Article  CAS  PubMed  Google Scholar 

  65. Poldermans D, Fioretti PM, Forster T et al (1993) Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery. Circulation 87:1506–1512

    Article  CAS  PubMed  Google Scholar 

  66. Karagiannis SE, Feringa HH, Vidakovic R et al (2007) Value of myocardial viability estimation using dobutamine stress echocardiography in assessing risk preoperatively before noncardiac vascular surgery in patients with left ventricular ejection fraction <35%. Am J Cardiol 99:1555–1559

    Article  PubMed  Google Scholar 

  67. Das MK, Pellikka PA, Mahoney DW et al (2000) Assessment of cardiac risk before nonvascular surgery: dobutamine stress echocardiography in 530 patients. J Am Coll Cardiol 35:1647–1653

    Article  CAS  PubMed  Google Scholar 

  68. Beattie WS, Abdelnaem E, Wijeysundera DN, Buckley DN (2006) A meta-analytic comparison of preoperative stress echocardiography and nuclear scintigraphy imaging. Anesth Analg 102:8–16

    Article  PubMed  Google Scholar 

  69. Shaw LJ, Eagle KA, Gersh BJ et al (1996) Meta-analysis of intravenous dipyridamole-thallium-201 imaging (1985 to 1994) and dobutamine echocardiography (1991 to 1994) for risk stratification before vascular imaging. J Am Coll Cardiol 27:787–798

    Article  CAS  PubMed  Google Scholar 

  70. Kertai MD, Boersma E, Bax JJ et al (2003) A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery. Heart 89:1327–1334

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  71. Poldermans D, Arnese M, Fioretti PM et al (1997) Sustained prognostic value of dobutamine stress echocardiography for late cardiac events after major noncardiac vascular surgery. Circulation 195:53–58

    Article  Google Scholar 

  72. Sicari R, Ripoli A, Picano E et al on behalf of the EPIC (Echo Persantine International Cooperative) Study Group (2002) Long-term prognostic value of dipyridamole echocardiography in vascular surgery: a large-scale multicenter study. Coron Artery Dis 13:49–55

    Google Scholar 

  73. Luscher TF, Gersh B, Landmesser U, Ruschitzka F (2014) Is the panic about beta-blockers in peri-operative care justified? Eur Heart J 35:2442–2444

    Article  PubMed  Google Scholar 

  74. Cortigiani L, Bigi R, Bovenzi F, Molinaro S, Picano E, Sicari R (2012) Prognostic implication of appropriateness criteria for pharmacologic stress echocardiography performed in an outpatient clinic. Circ Cardiovasc Imaging 5:298–305

    Article  PubMed  Google Scholar 

  75. Seidman A, Hudis C, Pierri M et al (2002) Cardiac dysfunction in the trastuzumab clinical trials experience. J Clin Oncol 20:1215–1221

    Article  CAS  PubMed  Google Scholar 

  76. Tsai HR, Gjesdal O, Wethal T et al (2011) Left ventricular function assessed by two-dimensional speckle tracking echocardiography in long-term survivors of Hodgkin’s lymphoma treated by mediastinal radiotherapy with or without anthracycline therapy. Am J Cardiol 107:472–477

    Article  PubMed  Google Scholar 

  77. Swain S, Whaley F, Ewer M (2003) Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer 97:2869–2879

    Article  CAS  PubMed  Google Scholar 

  78. European Society of Cardiology Working Groups on Nuclear Cardiology and Cardiac Computed Tomography and Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, Society for Cardiovascular Magnetic Resonance, Society of Cardiovascular Computed Tomography, Lancellotti P, Nkomo VT, Badano LP et al (2013) Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 14:721–740

    Article  Google Scholar 

  79. Plana JC, Galderisi M, Barac A et al (2014) Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 15:1063–1093

    Article  PubMed Central  PubMed  Google Scholar 

  80. Heidenreich P, Schnittger I, Strauss H et al (2007) Screening for coronary artery disease after mediastinal irradiation for Hodgkin’s disease. J Clin Oncol 25:43–49

    Article  PubMed  Google Scholar 

  81. Cottin Y, L’huillier I, Casasnovas O et al (2000) Dobutamine stress echocardiography identifies anthracycline cardiotoxicity. Eur J Echocardiogr 1:180–183

    Article  CAS  PubMed  Google Scholar 

  82. Civelli M, Cardinale D, Martinoni A et al (2006) Early reduction in left ventricular contractile reserve detected by dobutamine stress echo predicts high-dose chemotherapy-induced cardiac toxicity. Int J Cardiol 11:120–126

    Article  Google Scholar 

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Authors and Affiliations

  1. Cardiovascular Ultrasound, Institute of Clinical Physiology, CNR, Pisa, Italy

    Rosa Sicari PhD

  2. Department of Cardiology, Albert Szent-Gyorgt University, Szeged, Hungary

    Rosa Sicari PhD & Albert Varga

  3. CNR Pisa, Ist. Fisiologia Clinica, Via Moruzzi 1, Pisa, 56124, Italy

    Eugenio Picano

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Sicari, R., Varga, A., Picano, E. (2015). Special Subsets of Clinically Defined Patients: Elderly, Women, Outpatients, Chest Pain Unit, Noncardiac Surgery, Cancer. In: Stress Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-319-20958-6_29

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