Diagnosis of coronary artery disease and viable myocardium by stress echocardiography. Diagnostic accuracy of different stress modalities.

Stress echocardiography is being used more commonly for routine clinical diagnosis of coronary artery disease. In addition to physical treadmill or bicycle exercise echocardiography, pharmacological stress echocardiography with dobutamine and dipyridamole has also gained increasing significance over the past few years. Numerous studies have proven that these methods diagnose coronary artery disease accurately (exercise echocardiography: sensitivity 71 to 98%, specificity 64 to 100%, dobutamine echocardiography; sensitivity 54 to 96%, specificity 66 to 95%; dipyridamole echocardiography: sensitivity 57 to 74%, specificity 80 to 100%), but no direct comparison has hitherto been able to prove the superiority of any one of these protocols. However it is recognized that the skill and experience of the echocardiographer performing this study has an influence on the accuracy of the technique.