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Stress echocardiography. Part II: Stress echocardiography in conditions other than coronary heart disease

Edyta Płońska-Gościniak
Edyta Płońska-Gościniak
, 
Tomasz Kukulski
Tomasz Kukulski
, 
Jarosław D. Kasprzak
Jarosław D. Kasprzak
, 
Zbigniew Gąsior
Zbigniew Gąsior
, 
Andrzej Szyszka
Andrzej Szyszka
, 
Andrzej Gackowski
Andrzej Gackowski
, 
Wojciech Braksator
Wojciech Braksator
, 
Piotr Gościniak
Piotr Gościniak
, 
Piotr Pysz
Piotr Pysz
, 
Szymon Olędzki
Szymon Olędzki
 and 
Wojciech Kosmala
Wojciech Kosmala
   | Apr 30, 2019
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Article Category: review
Published Online: Apr 30, 2019
Page range: 49 - 53
Received: Aug 15, 2018
Accepted: Jan 30, 2019
DOI: https://doi.org/10.15557/jou.2019.0007
Keywords
© 2019 Edyta Płońska-Gościniak et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Dobutamine stress echo protocol and parameters recorded at each test stage(1). LV – left ventricle, SV – stroke volume, AVA – aortic valve area, BP – blood pressure
Dobutamine stress echo protocol and parameters recorded at each test stage(1). LV – left ventricle, SV – stroke volume, AVA – aortic valve area, BP – blood pressure

Fig. 2.

Protocol for stress echo (SE) using cycle ergometer or trade-mill. Parameters recorded at each test stage are shown: MR – mitral regurgitation, RV – right ventricle, LV – left ventricle, LVOT – left ventricular outflow tract, PB – blood pressure, SPAP – systolic pulmonary artery pressure(1)
Protocol for stress echo (SE) using cycle ergometer or trade-mill. Parameters recorded at each test stage are shown: MR – mitral regurgitation, RV – right ventricle, LV – left ventricle, LVOT – left ventricular outflow tract, PB – blood pressure, SPAP – systolic pulmonary artery pressure(1)

Fig. 3.

The usefulness of stress echo (SE) in the assessment of acquired valvular defects. The following parameters are individually assessed: valvular function alone, LV and RV function, and other hemodynamic consequences of the defect(1). MR – mitral regurgitation, MS – mitral stenosis, AR – aortic regurgitation, AS – aortic stenosis, SV – stroke volume, MPG - mean pressure gradient, PH – pulmonary hypertension
The usefulness of stress echo (SE) in the assessment of acquired valvular defects. The following parameters are individually assessed: valvular function alone, LV and RV function, and other hemodynamic consequences of the defect(1). MR – mitral regurgitation, MS – mitral stenosis, AR – aortic regurgitation, AS – aortic stenosis, SV – stroke volume, MPG - mean pressure gradient, PH – pulmonary hypertension

Threshold values of stress echo parameters associated with prognosis and treatment response. DE – dobutamine stress echo, SE- exercise stress echo, EF – ejection fraction, SV - stroke volume, WMSI – contractility index

Parameters Threshold values
Left intraventricular obstruction LVOT gradient >50 mm Hg
Impaired functional reserve ∆ WMSI <0.25 in ectatic cardiomyopathy (SE, DE)∆ EF <7.5% in NS and CRT patients (SE, DE)∆ EF <4.5% in primary MR and AR (SE)∆ Global longitudinal strain <2% in organic MR (SE)
Impaired flow reserve ∆ SV <20% (DE)
Dynamic mitral regurgitation ∆ EROA >13 mm2 in functional MR (SE)
Systolic pulmonary hypertension SPAP >60 mm Hg (SE)
Limited valvular compliance Mean diastolic gradient in mitral stenosis>15 mm Hg (SE); >18 mm Hg (DE)Systolic gradient in aortic stenosis >18 mm Hg (SE)
Prosthetic malfunction Mean diastolic gradient in mitral position >10 mm Hg (SE, DE)Mean systolic gradient in aortic position >20 mm Hg (SE, DE)
Functional stenosis after mitral ring plasty Mean diastolic gradient >7 mm Hg
RV dysfunction TAPSE <19 mm in limited MR (SE)

Diagnostic end-points and reasons for stress echo interruption

Diagnostic end-points Reasons for test interruption Improper test criteria (>1 criterion)
Maximum dobutamine dose/maximum exercise Intolerable symptoms Symptoms: angina pectoris, dyspnea, syncope, fatigue at low stress level
Target heart rate Muscular fatigue Ischemia (ST drop by >2 mm vs baseline)
Typical changes in ECG Hypertension (220/120 mm Hg) New disorders of regional contractility
Typical changes in echocardiogram Symptomatic hypotension (decrease by >40 mm Hg) Arrhythmias (NSVT, SVT)
Retrosternal pain Arrhythmias (SVT, AF, multiple ventricular ectopic beats) Specific end-points*
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Language:
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Journal Subjects:
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