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: Suspected or known coronary artery disease (CAD). Intervention: Stress echocardiography (exercise, dobutamine, or dipyridamole stress) vs. Radionuclide myocardial perfusion imaging and coronary angiography. Primary outcome: Diagnostic accuracy (sensitivity and specificity for CAD) and prognostic value for cardiac events.

Nithima Chaowalit; Patricia A. Pellikka

doi:10.15420/apc.2008:2:1:59

January 1, 2008Asia Pacific CardiologyOpen 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 matches radionuclide myocardial perfusion imaging in diagnostic accuracy for detecting CAD.

Key Points

Review the history, diagnostic accuracy, and emerging technological advancements of stress echocardiography for evaluating coronary artery disease.
Reviewed historical milestones and clinical utility of exercise, dobutamine, and dipyridamole stress echocardiography protocols.
Summarized multi-study diagnostic accuracy data evaluating wall motion abnormalities and emerging modalities, including contrast, strain rate, and 3D imaging.
Across historical evaluations, dobutamine stress echocardiography demonstrated diagnostic sensitivity ranging from 70% to 96%, specificity from 50% to 94%, and overall accuracy from 64% to 89% for coronary artery disease.
In head-to-head comparisons, dipyridamole showed sensitivity ranging from 52% to 93% and specificity from 67% to 97%, whereas dobutamine demonstrated sensitivity from 57% to 95% and specificity from 63% to 97%.
Technological additions such as contrast cavity opacification and tissue Doppler strain rate imaging improve endocardial border visualization, myocardial perfusion assessment, and viability detection.

Structured PICO

P

Population

Patients with known or suspected coronary artery disease (CAD) undergoing diagnostic or prognostic evaluation

I

Intervention

Stress echocardiography utilizing exercise (treadmill, supine or upright bicycle) or pharmacological stressors (dobutamine infusion 5-40 g/kg/minute +/- atropine 0.25 mg increments up to 1-2 mg; or dipyridamole), including adjunctive contrast, strain rate, and 3D imaging

C

Comparator

Stress radionuclide myocardial perfusion imaging and coronary angiography

O

Outcome

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

Stress echocardiography is an established, versatile, and radiation-free mainstay for diagnosing and risk-stratifying coronary artery disease, with emerging contrast, strain rate, and 3D techniques poised to enhance quantification and sensitivity.

Limitations

Dependence on image quality and difficult recognition of ischaemia in the setting of extensive resting wall motion abnormalities
Post-test referral bias in diagnostic accuracy studies
Lack of standardised technique for contrast stress echocardiography
Lack of standardised methodology and consensus on parameters for strain and strain rate imaging
Limited data regarding the use of 3D echocardiography in stress echocardiography
Variations in angiographic cut-off for significant CAD, population studied, and adequacy of stress across accuracy studies
Post-test referral bias affecting apparent specificity and sensitivity in clinical practice
Challenging recognition of ischaemia in the setting of extensive resting wall motion abnormalities and dependence on image quality
Lack of a standardised technique for contrast stress echocardiography and strain/strain rate imaging

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Implication

May favor stress echocardiography to reduce radiation exposure in CAD evaluation; leaves open refinement with advanced techniques in prospective studies.

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 Suspected or known coronary artery disease (CAD). Stress echocardiography (exercise, dobutamine, or dipyridamole stress) vs. Radionuclide myocardial perfusion imaging and coronary angiography was evaluated on Diagnostic accuracy (sensitivity and specificity for CAD) and prognostic value for cardiac events. Stress echocardiography provides comparable diagnostic accuracy to radionuclide myocardial perfusion imaging for detecting coronary artery disease and offers established prognostic value.

synapsesocial.com/papers/6a7a005e77336a1bae029562 https://doi.org/10.15420/apc.2008:2:1:59

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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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