Exercise is the most physiologic of all stressors and, thus, is preferable in patients who are capable of exercising. For the diagnosis of coronary artery disease, exercise echocardiography is an appropriate first-line test, skipping the exercise electrocardiography test, in patients with conditions that make the ECG uninterpretable, such as left bundle branch block or Wolff-Parkinson-White syndrome or ST segment abnormalities on baseline resting ECG. Exercise echocardiography is also the most suitable second-line stress test, when exercise ECG, performed as a first-line examination, reproduced ST segment depression and/or angina, when the positive predictive value of these findings remains low (for instance, in women and/or hypertensive subjects). Exercise stress echocardiography is frequently performed inappropriately, like all other stress imaging testing, as a first-line test in patients with a low pretest probability of disease and in whom the ECG is interpretable. There are contraindications to exercise echocardiography, such as the classical contraindications to exercise stress, including unstable hemodynamic conditions or severe, uncontrolled hypertension. An additional relative contraindication to exercise stress is the inability to exercise adequately and specifically for exercise echocardiography – a difficult resting echocardiogram. These conditions are not infrequent, especially in the elderly population, since out of five patients referred for testing, one is unable to exercise, one exercises submaximally, and one has an interpretable but challenging echocardiogram, which makes pharmacological stress echocardiography a more practical option. A unique advantage of exercise echocardiography over the other forms of stress is that it may offer a helpful and tremendously versatile evaluation of valve function or pulmonary hemodynamics, which is of key importance in special subsets of patients, such as patients with heart failure, pulmonary hypertension, or valve disease. In all these patients, the physiologic nature of exercise stress and the staggering versatility of the echocardiographic technique allow one to tailor the most appropriate test to the individual patient in the stress echocardiography laboratory.
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Keywords
- Coronary Flow Reserve
- Wall Motion Abnormality
- Stress Echocardiography
- Chronic Stable Angina
- Exercise Echocardiography
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Piérard, L.A., Picano, E. (2009). Exercise Echocardiography. In: Picano, E. (eds) Stress Echocardiography. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-76466-3_11
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