Stress Echocardiography. Part I. Exercise Echocardiography: Techniques, Implementation, Clinical Applications, and Correlations

To describe the techniques and applications of exercise echocardiography. We review pertinent experimental and clinical studies from the literature and present our experience with the first 2,000 patients who underwent exercise echocardiography in our laboratory. The indications for and contraindications to exercise echocardiography and the advantages, limitations, and accuracy of this procedure in comparison with other techniques for detecting coronary artery disease are discussed. Exercise echocardiography is increasingly used for the noninvasive evaluation of coronary artery disease because, in addition to its diagnostic capabilities, it offers attractive features such as portability, versatility, rapid availability of results, and relatively low cost. For accurate interpretation of the results, the workload achieved and the time between completion of exercise and image acquisition must be considered. The major limitation of exercise echo-cardiography is the high degree of operator dependence. For accurate interpretation of regional wall motion abnormalities and recognition of ischemic changes, specific training and extensive experience are necessary. Although exercise echocardiography has only relatively recently become a widely used technique, it has proved to have considerable accuracy in the diagnosis of coronary artery disease (mean sensitivity, 84%; mean specificity, 87%). In high-volume laboratories, feasibility studies have shown success rates between 90 and 99 %; thus far, reproducibility has been satisfactory. Other applications of exercise echocardiography being studied are follow-up monitoring after revascularization, determination of prognosis, and assessment of valvular heart disease.