Stress echocardiography: A historical perspective

Stress echocardiography (SE) provides a dynamic evaluation of myocardial structure and function under conditions of physiologic or pharmacological stress [1, 2]. Both specialty recommendations [3, 4] and general cardiology guidelines [5, 6] recommend SE as a primary tool for evaluating patients with established or suspected coronary artery disease (CAD). However, the ultrasound images obtained during conventional SE provide far more information. From an SE era with a one-fits-all approach (wall motion by 2D echo in the patient with known or suspected coronary artery disease), now we have moved on to a highly diverse, next–generation laboratory employing a variety of technologies (from M-mode to 2D and pulsed, continuous, color and tissue Doppler, to lung ultrasound and real–time 3D echo, 2D speckle tracking, and myocardial contrast echo) on patients covering the entire spectrum of severity (from elite athletes to patients with end–stage heart failure) and ages (from children with congenital heart disease to the elderly with low–flow, flow–gradient aortic stenosis) (Fig. 1.1) [7].