Chronic stable angina exercise echocardiography

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Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Cafer Zorkun, M.D., Ph.D. [2]; Associate Editor-in-Chief: Smita Kohli, M.D.

Exercise echocardiography

• This appears to be more sensitive and more specific and to have a higher predictive value than exercise ECG.

• Exercise echocardiography has been reported to have a sensitivity of 74% to 100% and a specificity of 64% to 93% for detecting CAD.

• Good agreement has also been reported between stress echocardiography and stress scintigraphy.

• With the use of high dose of dobutamine (up to 50 gm / kg / min), a method of dobutamine stress echocardiography can be performed with 86% to 96% of sensitivity and 66% to 95% of specificity.

• Lower doses of dobutamine can also be used to detect hibernating myocardium. Areas of hibernating myocardium exhibit poor or absent contraction at rest but normal contraction during dobutamine infusion. By comparison, areas damaged by myocardial infarction or fibrosis exhibit no improvement with dobutamine.

ACC / AHA Guidelines- Exercise Echocardiography in patients Who Are Able to Exercise (DO NOT EDIT)

“

Class I 1. Exercise myocardial perfusion imaging or exercise echocardiography in patients with an intermediate pretest probability of CAD who have 1 of the following baseline ECG abnormalities: a. Preexcitation (Wolff-Parkinson-White) syndrome. (Level of Evidence: B) b. More than 1 mm of rest ST depression. (Level of Evidence: B) 2. Exercise myocardial perfusion imaging or exercise echocardiography in patients with prior revascularization (either percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG). (Level of Evidence: B) Class IIb 1. Exercise myocardial perfusion imaging and exercise echocardiography in patients with a low or high probability of CAD who have 1 of the following baseline ECG abnormalities: a. Preexcitation (Wolff-Parkinson-White) syndrome. (Level of Evidence: B) b. More than 1 mm of ST depression. (Level of Evidence: B) 2. Exercise myocardial perfusion imaging or exercise echocardiography in patients with an intermediate probability of CAD who have 1 of the following: a. Digoxin use with <1 mm ST depression on their baseline ECG. (Level of Evidence: B) b. LV hypertrophy with <1 mm ST depression on their baseline ECG. (Level of Evidence: B) 3. Exercise myocardial perfusion imaging, exercise echocardiography, adenosine or dipyridamole myocardial perfusion imaging, or dobutamine echocardiography as the initial stress test in a patient with a normal rest ECG who is not taking digoxin. (Level of Evidence: B) 4. Exercise or dobutamine echocardiography in patients with left bundle-branch block. (Level of Evidence: C)

”

ESC Guidelines for the use of exercise stress with imaging techniques (either echocardiography or perfusion) in the initial diagnostic assessment of angina (DO NOT EDIT)

“

Class I 1. Patients with resting ECG abnormalities, LBBB, more than 1 mm ST-depression, paced rhythm, or WPW which prevent 12 ESC Guidelines accurate interpretation of ECG changes during stress. (Level of Evidence: B) 2. Patients with a non-conclusive exercise ECG but reasonable exercise tolerance, who do not have a high probability of significant coronary artery disease and in whom the diagnosis is still in doubt. (Level of Evidence: B) Class IIa 1. Patients with prior revascularization (PCI or CABG) in whom localization of ischaemia is important. (Level of Evidence: B) 2. As an alternative to exercise ECG in patients where facilities, cost, and personnel resources allow. (Level of Evidence: B) 3. As an alternative to exercise ECG in patients with a low pre-test probability of disease such as women with atypical chest pain. (Level of Evidence: B) 4. To assess functional severity of intermediate lesions on coronary arteriography. (Level of Evidence: C) 5. To localize ischaemia when planning revascularization options in patients who have already had arteriography. (Level of Evidence: B)

”

See Also

• The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Sources

• Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology

• The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina

• TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina

• The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina

References

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