Stress Echocardiogram

1. See Also
   1. Exercise Stress Test
   2. Stress Imaging
   3. Pharmacologic Stress Test
   4. Stress Myocardial Perfusion Imaging
   5. Echocardiogram
   6. Echocardiogram in Congestive Heart Failure
2. Background
   1. Most cost-effective, versatile Cardiac Imaging
3. Indications
   1. Chest Pain Evaluation if no suspected Aortic Dissection
   2. Nondiagnostic Stress EKG, Intermediate CAD likelihood
      1. Resting ST-T Wave abnormalities
      2. Left Bundle Branch Block
      3. Ventricular paced rhythm
      4. Left Ventricular Hypertrophy
      5. Digoxin treatment
   3. CAD Diagnosis, risk stratification, and therapy
      1. Assessment of left ventricular systolic function
      2. Identify lesions in planning for PTCA intervention
      3. Risk stratification prior to noncardiac surgery
4. Advantages
   1. Lower cost
   2. Determines Ejection Fraction
   3. Can determine ventricular volume
   4. Assess valvular regurgitation
   5. Assesses diastolic function
5. Disadvantages
   1. Operator dependent
   2. Large body habitus interferes with echo windows
      1. Definitiy (Perflutren Lipid Microsphere) or optison contrast can be used to increase accuracy
   3. Lower Test Sensitivity for ischemia
      1. More than 20% of Myocardium must be ischemic to demonstrate a wall motion abnormality
6. Efficacy
   1. Stress Echocardiogram
      1. Test Sensitivity: 81%
      2. Test Specificity: 86%
   2. Dobutamine Echocardiogram
      1. Test Sensitivity: >75%
      2. Test Specificity: >79%