Stănescu Cristina
Clinic of Internal Medicine, "Colentina" Hospital University of Medicine and Pharmacy, Bucharest, Romania.
Rom J Intern Med. 2004;42(3):473-89.
Exercise echocardiography is one of the stress echocardiography modalities, widely used nowadays, mainly in the patients with coronary artery disease. It is a first-line technique for the diagnosis of coronary disease and for prognostication in various patients' subsets, including patients with chronic coronary artery disease, patients with recent revascularization or myocardial infarction and women. This method relies on the fact that in the presence of a significant coronary stenosis, an adequate level of physical exertion produces a mismatch between oxygen demand and supply, resulting in a wall motion abnormality in the area supplied by that stenotic artery. The wall motion abnormalities that develop are detectable by echocardiography and are a marker of the degree of ischemia. The most commonly employed forms of exercise in conjunction with echocardiography are immediate post exercise imaging on a treadmill and exercising during supine or upright bicycle ergometry. Echocardiograms can be interpreted qualitatively, with a description of the recorded wall motion abnormalities, or quantitatively, calculating a wall motion score. The overall accuracy of exercise echocardiography in the diagnosis of coronary artery disease is about 80-90%. Exercise echocardiography has been shown to provide useful information for the purpose of risk stratification and prediction of coronary events after acute myocardial infarction, after angioplasty and after coronary artery bypass grafting. In women, the accuracy of electrocardiographic stress testing is less than in men and stress echocardiography offers a better alternative in the diagnosis of ischemic heart disease. For the patients with an intermediate pre-test probability of having ischemic heart disease and a resting electrocardiogram which precludes an optimal interpretation of the electrocardiographic stress test (digoxin use, left ventricular hypertrophy with repolarization abnormalities, preexcitation, or left bundle-branch block), exercise echocardiography represents a good alternative to radionuclide imaging.
运动超声心动图是负荷超声心动图的一种方式，目前应用广泛，主要用于冠心病患者。它是诊断冠心病以及对各类患者亚组（包括慢性冠心病患者、近期接受血运重建或心肌梗死的患者以及女性患者）进行预后评估的一线技术。该方法基于这样一个事实：在存在明显冠状动脉狭窄的情况下，适度的体力活动会导致氧需求与供应不匹配，从而在该狭窄动脉供血区域产生室壁运动异常。超声心动图可检测到所出现的室壁运动异常，它是缺血程度的一个标志。与超声心动图结合使用的最常见运动形式是在跑步机上运动后立即成像以及在仰卧或直立状态下进行自行车测力计运动时成像。超声心动图可进行定性解读，描述记录到的室壁运动异常情况，也可进行定量解读，计算室壁运动评分。运动超声心动图诊断冠心病的总体准确率约为80% - 90%。运动超声心动图已被证明可为急性心肌梗死后、血管成形术后以及冠状动脉旁路移植术后的风险分层和冠状动脉事件预测提供有用信息。在女性中，心电图负荷试验的准确性低于男性，负荷超声心动图在缺血性心脏病诊断中提供了更好的选择。对于缺血性心脏病预测试验概率中等且静息心电图妨碍对心电图负荷试验进行最佳解读（使用地高辛、左心室肥厚伴复极异常、预激或左束支传导阻滞）的患者，运动超声心动图是放射性核素成像的良好替代方法。
