Stress Echocardiography: A Historical Perspective (or, How I Ate My Father)

  • Eugenio Picano


As happens with any scientific innovation, stress echocardiography completed its life cycle by moving from the status of “promising innovation”, used by a few enthusiastic supporters amid general skepticism, up to the rank of “established technology” accepted by virtually the whole cardiological community (Fig. i) — sometimes even overused, with an embarassing lack of common sense tending to transform the technique into a totem — whose responses, taken out of the overall clinical context, may produce more problems than solutions in patient management. The impressive increase in the amount of editorial space devoted to stress echo in major journals and meetings testifies to its increased acceptance by cardiologists (Fig. 2). Ten years ago, stress echo was a scientific fact without clinical substance: an academic somersault in front of empty seats. At present, the real risk for stress echo is to become a clinical fact without scientific substance: all laboratories do stress echo, but often in the wrong way and/or with inappropriately selected patients.


Nuclear Cardiology Stress Echocardiography Pharmacological Stress Variant Angina Established Technology 
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  1. 1.
    Lewis R (1994) The evolution man - or, how I ate my father. Vintage, New YorkGoogle Scholar
  2. 2.
    Tennant R, Wiggers CJ (1935) The effects of coronary occlusion on myocardial contraction. Am J Phys 112: 351 - 361Google Scholar
  3. 3.
    Theroux P, Franklin D, Ross J jr, Lemper WS (1974) Regional myocardial function during acute coronary artery occlusion and its modification by pharmacologic agents in the dog. Circ Res 34: 896 - 908CrossRefGoogle Scholar
  4. 4.
    Kerber RE, Abboud FM (1973) Echocardiographic detection of regional myocardial infarction. An experimental study. Circulation 47: 997-1005Google Scholar
  5. 5.
    Widlansky S, McHenry PL, Corya BC, et al. (1975) Coronary angiographic, echocardiographic and electrocardiographic studies on a patient with variant angina due to a coronary artery spasm. Am Heart J 9o: 631 - 635CrossRefGoogle Scholar
  6. 6.
    Sugishita Y, Koshi S, Matsudo M, Tamura T, Yamaguchi I, Ito I (1984) Dissociation between regional myocardial disfunction and ECG changes during myocardial ischemia induced by exercise in patients with angina pectoris. Am Heart J 1o6: 1 - 8Google Scholar
  7. 7.
    Distante A, Rovai D, Picano E, Moscarelli E, Palombo C, Morales MA, Michelassi C, L’Abbate A (1984) Transient changes in left ventricular mechanics during attacks of Prinzmetal’s angina: an M-mode echocardiographic study. Am Heart J 107: 465 - 47oPubMedCrossRefGoogle Scholar
  8. 8.
    Wann LS, Faris JV, Childress RH, Weyman AE, Feigenbaum H (1979) Exercise cross-sectional echocardiography in ischemic heart disease. Circulation 60: 1300 - 1308PubMedCrossRefGoogle Scholar
  9. 9.
    Picano E, Distante A, Masini M, Morales MA, Lattanzi F, L’Abbate A (1985) Dipyridamoleechocardiography test in effort angina pectoris. Am J Cardiol 56: 452-456Google Scholar
  10. 10.
    Pierard LA, De Landsheere CM, Berthe C, Rigo P, Kulbertus HE (199o) Identification of viable myocardium by echocardiography during dobutamine infusion in patients with myocardial infarction after thrombolytic therapy: comparison with positron emission tomography. J Am Coll Cardiol 15:1021-1031.Google Scholar
  11. 11.
    Zaret BL (1996) Nuclear cardiology. In: Braunwald E (ed) Textbook of heart disease, 5th edn. Saunders, New YorkGoogle Scholar
  12. 12.
    Verani M (1994) Should all patients undergo cardiac catheterization after a myocardial infarction? J Nucl Cardiol 1:S 134-146Google Scholar
  13. 13.
    Hugenholtz PG (1991) Ischemic heart disease: left ventricular function and coronary heart disease. Chairman’s overview. In: Nitter-Hauge S, Allison D (eds) Cardiac imaging: X-ray, MR, and ultrasound. Excerpta Medica, Amsterdam, International Congress Series, no. 922, Pp 131 - 140Google Scholar
  14. 14.
    McKinley JB (1981) From promising report to standard procedure: seven stages in the career of a medical innovation. Milbank Mem Fund Q 59: 374 - 411CrossRefGoogle Scholar
  15. 15.
    Falk E (1992) Why do plaques rupture? Circulation [Suppl III]: III30-III42Google Scholar
  16. 16.
    Strauss WH (1996) Imaging of atherosclerosis. A worthy challenge. J Nucl Cardiol 3: 278 - 280PubMedCrossRefGoogle Scholar
  17. 17.
    Lanza G, Wallace KD, Scott MJ, Cacheris WP, Abendschein DR, Christy DH, Sharkey AM, Miller JG, Gaffney PJ, Wickline SA(1996) A novel site - targeted ultrasonic contrast agent with broad biomedical application. Circulation 95: 3334 - 3340Google Scholar

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© Springer-Verlag Berlin Heidelberg 1997

Authors and Affiliations

  • Eugenio Picano
    • 1
  1. 1.Institute of Clinical PhysiologyCNRPisaItaly

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