Barbieri Andrea, Bursi Francesca, Santangelo Gloria, Mantovani Francesca
Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy.
Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, 20122 Milan, Italy.
Rev Cardiovasc Med. 2022 Jul 26;23(8):275. doi: 10.31083/j.rcm2308275. eCollection 2022 Aug.
The modern conceptual revolution in managing patients with stable coronary artery disease (CAD), based on improvement in preventive and pharmacological therapy, advocates coronary artery revascularization only for smaller group of patients with refractory angina, poor left ventricular systolic function, or high-risk coronary anatomy. Therefore, our conventional wisdom about stress testing must be questioned within this new and revolutionary paradigm. Exercise stress echocardiography (ESE) is still a well-known technique for assessing known or suspected stable CAD, it is safe, accessible, and well-tolerated, and there is an widespread evidence base. ESE has been remarkably resilient throughout years of innovation in noninvasive cardiology. Its value is not to be determined over the short portion of diagnostic accuracy but mainly through its prognostic value evident in a wide range of patient subsets. It is coming very close to the modern profile of a leading test that should include, in addition to an essential accettable diagnostic and prognostic accuracy, qualities of low cost, no radiation exposure, and minor environmental traces. In this review, we will discuss advantages, diagnostic accuracy, prognostic value in general and special populations, cost-effectiveness, and changes in referral patterns of ESE in the modern era.
基于预防和药物治疗的改善，现代对稳定型冠状动脉疾病（CAD）患者的管理理念发生了变革，主张仅对一小部分难治性心绞痛、左心室收缩功能差或冠状动脉解剖结构高危的患者进行冠状动脉血运重建。因此，在这个全新的革命性范式下，我们关于负荷试验的传统观念必须受到质疑。运动负荷超声心动图（ESE）仍然是评估已知或疑似稳定型CAD的一项知名技术，它安全、可及且耐受性良好，并且有广泛的证据基础。在无创心脏病学多年的创新过程中，ESE一直非常有韧性。其价值并非由短期的诊断准确性来决定，而是主要通过其在广泛患者亚组中明显的预后价值来体现。它正非常接近一项领先检查的现代特征，除了基本可接受的诊断和预后准确性外，还应具备低成本、无辐射暴露和对环境影响小等特点。在这篇综述中，我们将讨论ESE在现代的优势、诊断准确性、在一般人群和特殊人群中的预后价值、成本效益以及转诊模式的变化。
