Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website http://www.cardiologyres.org

Review

Volume 11, Number 2, April 2020, pages 89-96

Stress Echocardiography: Concept and Criteria, Structure and Steps, Obstacles and Outcomes, Focused Update and Review

Figures

Figure 1.
Figure 1. Image showing regular DSE protocol (a) and (b) low dose DSE protocol. DSE: dobutamine stress echocardiography.
Figure 2.
Figure 2. Apical four-chamber view showing the mid-left ventricular diameter change at rest and with peak DSE. DSE: dobutamine stress echocardiography.
Figure 3.
Figure 3. The different left ventricular myocardial segments explored during DSE. DSE: dobutamine stress echocardiography.
Figure 4.
Figure 4. The different coronary territories with regard to left ventricular myocardial segments. LAD: left anterior descending; LCx: left circumflex; RCA: right coronary artery; Diag: diagonal branch.
Figure 5.
Figure 5. Deformation imaging method showing regional hypokinesis (mainly in the basal antero-septal, anterior and lateral segments) during a low dose DSE. DSE: dobutamine stress echocardiography.
Figure 6.
Figure 6. The different causes that may result in transaortic low flow status. LV: left ventricle; RV: right ventricle.
Figure 7.
Figure 7. Very low dobutamine protocol.
Figure 8.
Figure 8. Algorithm showing the different alternatives and outcome while implementing DSE in LF/LG aortic stenosis. DSE: dobutamine stress echocardiography; SV: stroke volume; MSCT: multislice computed tomography; AoV: aortic valve; Ca: calcium; MG: mean gradient; AVA: aortic valve area. LF/LG: low flow low gradient.

Tables

Table 1. The Four Equation Possibilities in Response to Stress
 
RestStressDiagnosis
NormokinesisNormo- to hyperkinesisNormal
NormokinesisHypokinesis to akinesis or dyskinesisIschemia
AkinesisHypo- to normokinesisViable
Akinesis or dyskinesisAkinesis or dyskinesisNecrosis

 

Table 2. Interpretation of DSE at Rest, With Low Dose Protocol and With Peak Dose
 
Nature of tissueRestLow dose dobutaminePeak dose dobutamine
DSE: dobutamine stress echocardiography.
Normal segmentNormalNormal or improvesHyperkinetic
Ischemic segmentNormalNormal or may worsenWorsens
Viable ischemicHypo- or akineticImprovesWorsens (biphasic response)
Infarcted segmentAkinetic or dyskineticAkinetic or dyskineticAkinetic or dyskinetic

 

Table 3. Changes in Echo Parameters During Stress
 
True severe ASPseudo-severe AS
+: minor increase; +++: significant increase; =: similar; -: decrease. AS: aortic stenosis; LVOT: left ventricle outflow tract.
Stroke volume and LVOT velocity++
Transvalvular gradients++++
Aortic valve area= or (-)+