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It is a test that involves real-time echocardiographic imaging of the left ventricular myocardium as well as assessing of some functional parameters in ischemic or valvular heart disease. The evaluation is performed before and after physical stress or during the gradually increased pharmacological or electrical stress. However, the most commonly performed echocardiographic stress test is that using pharmacological stress (dobutamine stress echocardiography [DSE]).
Stress echocardiography is a well-validated tool for the evaluation of ischemia. In particular, it is an appropriate first-line test in patients who have baseline abnormalities on the electrocardiogram that preclude interpretation of exercise electrocardiograms. The accuracy of stress echocardiography is similar to that of stress radionuclide perfusion imaging. DSE can also be used to quantify viability (contractile reserve) and hence functional recovery after reperfusion (bypass surgery or stenting), although its overall sensitivity appears to be lower than that of nuclear and CMR studies. Moreover, it is feasible to assess coronary flow and flow reserve, most reliably in the LAD territory, by using Doppler transthoracic echocardiography and vasodilators (adenosine or dipyridamole) to provide additional prog¬nostic information. Microperfusion to the myocardium at rest and with stress echocardiography may also be demonstrated with the use of intravenous echocardiographic contrast enhancement on two- and three-dimensional images.
Stress echocardiography is a very versatile modality and is used to assess factors beyond left ventricular systolic function, particularly in patients who are dyspneic for unclear reasons. Valvular disease, diastolic function, pulmonary hypertension, and hemodynamics may all be assessed under stress conditions.
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