Diagnostik und Risikostratifikation der koronaren Herzkrankheit (KHK) : Aktuelle Bedeutung der Stressechokardiographie

Cost effective and early detection of patients with significant coronary artery disease (CAD) combined with prognostic evaluation are fundamental approaches of optimized patient treatment guidelines to lower morbidity and mortality of these patients. Stress echocardiography is an established and readily available diagnostic tool with the potential to evaluate global and regional left ventricular function at rest and during exercise combined with information regarding regional perfusion. The noninvasive detection of significant CAD without radiation is possible with reasonably high sensitivity and specificity and encompasses functional cardiovascular parameters as well as extent of the ischemic area. The likelihood of future cardiac events can be assessed with a high negative predictive accuracy, giving a high security aspect in the treatment options of patients prior to surgery. The potential of the diagnostic tool is CAD diagnostics with intermediate as well as high pretest probabilities. In patients under concurrent antiischemic medication identification of high risk patients seems feasible. Stress echocardiography has an excellent specificity and prognostic value for both the indication for as well as survival and benefit after revascularization. According to recent studies the detection of pathologic findings is not impaired by gender differences. New technical approaches include speckle and Doppler analysis of the myocardial wall and contrast-enhanced improvements in the myocardial border delineation, improving the image quality vital for the diagnostic power of this method. Very recent options of three-dimensional image acquisition and analysis are ready for further technical improvement and clinical validation.