How to perform stress echocardiography: practical aspects

Regional left ventricular systolic function is impaired by myocardial ischemia, and the extent and severity of ischemia determine the time-course and spatial distribution of these abnormalities. The principle of stress echocardiography is to image the heart at rest, and to compare these images with those obtained following stress, with the implication that deterioration in regional function corresponds to the presence of ischemia. The ability of echocardiography to record the severity of regional dysfunction, as well as its spatial extent and temporal distribution, permits an appreciation of the severity of coronary pathology as well as its presence or absence. As exercise-induced ischemia is usually transient, the most reliable data are generally acquired at peak stress or (if peak images are not feasible) within the shortest possible time after exercise [1]. Moreover, the induced wall motion abnormality may be subtle if the stenosis is moderate, situated distally, or if the patient is stressed submaximally. These considerations dictate that stress echocardiograms need to be not only acquired rapidly, but should be of the highest quality as well. The successful performance of stress echocardiography is therefore based upon meticulous attention to practical detail.