Sicari Rosa, Cortigiani Lauro
CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124, Pisa, Italy.
Department of Cardiology, San Luca Hospital, Lucca, Italy.
Cardiovasc Ultrasound. 2017 Mar 21;15(1):7. doi: 10.1186/s12947-017-0099-2.
Stress echocardiography is an established technique for the assessment of extent and severity of coronary artery disease. The combination of echocardiography with a physical, pharmacological or electrical stress allows to detect myocardial ischemia with an excellent accuracy. A transient worsening of regional function during stress is the hallmark of inducible ischemia. Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging or magnetic resonance, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician.The evidence on its clinical impact has been collected over 35 years, based on solid experimental, pathophysiological, technological and clinical foundations. There is the need to implement the combination of wall motion and coronary flow reserve, assessed in the left anterior descending artery, into a single test. The improvement of technology and in imaging quality will make this approach more and more feasible. The future issues in stress echo will be the possibility of obtaining quantitative information translating the current qualitative assessment of regional wall motion into a number. The next challenge for stress echocardiography is to overcome its main weaknesses: dependance on operator expertise, the lack of outcome data (a widesperad problem in clinical imaging) to document the improvement of patient outcomes. This paper summarizes the main indications for the clinical applications of stress echocardiography to ischemic heart disease.
负荷超声心动图是评估冠状动脉疾病范围和严重程度的一项成熟技术。超声心动图与体力、药物或电负荷相结合，能够以极高的准确性检测心肌缺血。负荷期间局部功能的短暂恶化是诱发性缺血的标志。负荷超声心动图提供的诊断和预后准确性与放射性核素负荷灌注成像或磁共振成像相似，但成本大幅降低，对环境无影响，且对患者和医生无生物危害。基于坚实的实验、病理生理、技术和临床基础，关于其临床影响的证据已收集了35年。有必要将在左前降支评估的室壁运动和冠状动脉血流储备相结合，纳入单一检测。技术的改进和成像质量的提高将使这种方法越来越可行。负荷超声心动图未来的问题将是获得定量信息的可能性，即将当前对局部室壁运动的定性评估转化为数字。负荷超声心动图的下一个挑战是克服其主要弱点：依赖操作者的专业知识、缺乏记录患者预后改善情况的结局数据（这是临床成像中普遍存在的问题）。本文总结了负荷超声心动图在缺血性心脏病临床应用中的主要适应证。
