Past, Present and Future of Stress Echocardiography – How Far Have We Come and How Far Can We Go?

Q: What is the clinical evidence from this study?

Study design: Review. Population: Known or suspected coronary artery disease. Intervention: Stress echocardiography (exercise, dobutamine, dipyridamole) vs. Radionuclide myocardial perfusion imaging or coronary angiography. Primary outcome: Diagnostic accuracy (sensitivity and specificity) and prognostic value for coronary artery disease.

Nithima Chaowalit; Patricia A. Pellikka

doi:10.15420/ecr.2008.4.1.59

January 1, 2008European Cardiology ReviewOpen Access

Past, Present and Future of Stress Echocardiography – How Far Have We Come and How Far Can We Go?

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Key result

Stress echocardiography delivers high diagnostic accuracy and strong prognostic value for coronary artery disease.

Why the study?

What is the diagnostic accuracy, prognostic value, and future clinical potential of exercise and pharmacological stress echocardiography in patients with known or suspected coronary artery disease?

Key Points

To review the historical evolution, diagnostic accuracy, and emerging technological developments of stress echocardiography in the evaluation of coronary artery disease.
Narrative review examining historical and clinical data on exercise and pharmacologic stress echocardiography (including dobutamine and dipyridamole protocols).
Evaluated diagnostic accuracy metrics across multiple published cohorts (sample sizes ranging from n=70 to n=306) and assessed newer modalities, including contrast, tissue Doppler, and 3D echocardiography.
Across historical evaluation cohorts, dobutamine stress echocardiography sensitivity for coronary artery disease ranged from 70% (n=80) to 96% (n=141), with specificity ranging from 50% (n=199) to 94% (n=104) and diagnostic accuracy ranging from 64% to 89%.
Head-to-head comparisons showed varying diagnostic performance between dipyridamole (sensitivities 52% to 93%, accuracies 63% to 84%) and dobutamine (sensitivities 57% to 95%, accuracies 65% to 87%).
Technical developments such as contrast opacification improve endocardial border visualization, while strain rate analysis during dobutamine infusion provides incremental value for detecting viable myocardial segments.

Structured PICO

What is the diagnostic accuracy, prognostic value, and future clinical potential of exercise and pharmacological stress echocardiography in patients with known or suspected coronary artery disease?

P

Population

Patients with known or suspected coronary artery disease undergoing exercise or pharmacological stress echocardiography for diagnosis and risk stratification.

I

Intervention

Stress echocardiography utilizing physical exercise (post-treadmill, supine or upright bicycle) or pharmacological stressors (dobutamine infusion starting at 5 ug/kg/min up to 40 ug/kg/min, or dipyridamole, with optional atropine 0.25 mg increments to 1-2 mg), as well as emerging adjuncts (contrast echocardiography, strain/strain rate imaging, real-time 3D echocardiography).

C

Comparator

Coronary angiography (reference standard for diagnostic accuracy) and stress radionuclide myocardial perfusion imaging; head-to-head comparisons between exercise, dobutamine, and dipyridamole stressors.

O

Outcome

Diagnostic accuracy (sensitivity, specificity, and overall accuracy for detecting CAD via inducible wall motion abnormalities) and prognostic value (prediction of mortality and cardiac events).surrogate

Stress echocardiography is an established, versatile, and radiation-free mainstay for CAD diagnosis and risk stratification, with emerging techniques like contrast perfusion, strain rate imaging, and 3D echocardiography poised to improve quantification and sensitivity.

Limitations

Variations in angiographic cut-off for significant CAD, study populations, and adequacy of stress across accuracy studies
Post-test referral bias resulting in apparent lower specificity and higher sensitivity in clinical practice
Dependence on image quality and difficulty recognizing ischemia in the setting of extensive resting wall motion abnormalities
Lack of standardized technique for contrast stress echocardiography and strain/strain rate imaging
Limited data regarding the use of 3D echocardiography in stress echocardiography
Variations in the angiographic cut-off for significant CAD, population studied, and adequacy of stress across accuracy studies
Post-test referral bias accounting for apparent lower specificity and higher sensitivity in clinical practice
Dependence on image quality and challenges in recognizing ischemia in the presence of extensive resting wall motion abnormalities
Lack of standardized technique for contrast stress echocardiography
Lack of standardized methodology and consensus on appropriate parameters for strain and strain rate imaging

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Implication

Reinforces stress echocardiography as a radiation-free CAD mainstay; leaves open the incremental value of emerging contrast, strain, and 3D techniques.

Abstract

How Far Have We Come? Cardiac imaging using ultrasound (so-called ‘echocardiography’) was introduced more than 50 years ago. Resting echocardiographic detection of myocardial infarction was described as the reduction in regional contractile function,1 and the development of stress echocardiography in the early era was recognised after the introduction of 2D echocardiographic imaging. The initial report in 1979 by Wann et al.

Discussion

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Cite This Study

Chaowalit et al. (2008) conducted a review in Known or suspected coronary artery disease. Stress echocardiography (exercise, dobutamine, dipyridamole) vs. Radionuclide myocardial perfusion imaging or coronary angiography was evaluated on Diagnostic accuracy (sensitivity and specificity) and prognostic value for coronary artery disease. Stress echocardiography provides high diagnostic accuracy and strong prognostic value for evaluating coronary artery disease.

synapsesocial.com/papers/6a7a005e77336a1bae029561 https://doi.org/10.15420/ecr.2008.4.1.59

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Past, Present and Future of Stress Echocardiography – How Far Have We Come and How Far Can We Go?

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Past, Present and Future of Stress Echocardiography – How Far Have We Come and How Far Can We Go?

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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