Diagnosis of Cardiac Damage: Role of Stress Echo

Stress echocardiography represents a valuable technique to reveal occult left ventricular dysfunction and coronary artery disease induced by chemo- and radiotherapy treatments. Indeed stress echocardiography can drive rapid cardiac intervention in terms of both chemotherapy dosage reduction and cardio protective strategies. Main indications for stress echocardiography are (i) suspect of coronary artery disease, (ii) evaluation of newly diagnosed LV dysfunction and (iii) assessment of new-onset valvular heart disease. The principal stressors used to reveal chemotherapy-induced cardiac damage are exercise, dobutamine and dipyridamole. Since sensitivity and specificity of different stressors are almost comparable, in cancer patients, the choice of the stressor can be selected according to safety, side effects and efficacy. To detect early signs of left ventricular dysfunction induced by chemotherapy, a complete evaluation of systolic and diastolic function at rest and after stress should be performed. Contractile reserve assessed by either ejection fraction or speckle tracking echocardiography should be determined considering its diagnostic and prognostic power. New technologies applied to stress echocardiography, such as three-dimensional evaluation, would overcome temporal and geometric assumption, but it shows several limitations that reduce its use in clinical practice.