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Stress Echocardiography

Current Methodology and Clinical Applications

William F. Armstrong, MD, FACC^_*,_* and William A. Zoghbi, MD, FACC

^_* Departments of Internal Medicine, Divisions of Cardiology, University of Michigan, Ann Arbor, Michigan
Baylor College of Medicine, Houston, Texas

View larger version (155K): [in a new window]   Figure 1 Parasternal long-axis echocardiogram recorded at rest (left) and immediately after exercise (right) in a patient with stenosis of the left anterior descending coronary artery. Diastolic frames are on the top, and systolic frames are on the bottom. At rest, notice the normal contraction of the septum and posterior wall. Immediately after exercise, the proximal septum has normal contractility (downward pointing arrow), and there is dyskinesia of the distal ventricular septum (upward pointing arrows).

View larger version (30K): [in a new window]   Figure 2 Three-dimensional model of probability of a cardiac event over the ensuing five years after exercise echocardiography versus risk index, derived from the exercise wall motion score index (ExWMSI), occurrence of ischemic ST-segment change at maximal exercise (ST = 0 or 1), and treadmill exercise time (on Bruce protocol, in min). Reproduced from Mazur et al. (27), with permission.

View larger version (18K): [in a new window]   Figure 3 Dobutamine stress echocardiography (DSE) in ischemic left ventricular (LV) dysfunction impact on survival. Mortality rates at a mean follow-up of 18 ± 10 months in patients with chronic LV dysfunction, grouped by the presence of viability by DSE and by whether or not patients underwent revascularization (+Rev and –Rev, respectively). *p = 0.01 vs. others. Modified from Afridi et al. (45), and reproduced with permission.

View larger version (121K): [in a new window]   Figure 4 Dipyridamole (Dip) stress contrast echocardiography using real-time perfusion imaging at a low mechanical index, showing images at end diastole and end systole in a patient with significant stenosis of the left anterior descending coronary artery. Note the perfusion defect that developed in the apex (highlighted by arrows) and the corresponding wall motion abnormality.