Have a personal or library account? Click to login
Stress echocardiography. Part II: Stress echocardiography in conditions other than coronary heart disease Cover

Stress echocardiography. Part II: Stress echocardiography in conditions other than coronary heart disease

Journal of Ultrasonography
Volume 19 (2019): Issue 76 (March 2019)
By: Edyta Płońska-Gościniak,  Tomasz Kukulski,  Jarosław D. Kasprzak,  Zbigniew Gąsior,  Andrzej Szyszka,  Andrzej Gackowski,  Wojciech Braksator,  Piotr Gościniak,  Piotr Pysz,  Szymon Olędzki and  Wojciech Kosmala  
Open Access
|Apr 2019

Figures & Tables

Fig. 1.

Dobutamine stress echo protocol and parameters recorded at each test stage(1). LV – left ventricle, SV – stroke volume, AVA – aortic valve area, BP – blood pressure
Dobutamine stress echo protocol and parameters recorded at each test stage(1). LV – left ventricle, SV – stroke volume, AVA – aortic valve area, BP – blood pressure

Fig. 2.

Protocol for stress echo (SE) using cycle ergometer or trade-mill. Parameters recorded at each test stage are shown: MR – mitral regurgitation, RV – right ventricle, LV – left ventricle, LVOT – left ventricular outflow tract, PB – blood pressure, SPAP – systolic pulmonary artery pressure(1)
Protocol for stress echo (SE) using cycle ergometer or trade-mill. Parameters recorded at each test stage are shown: MR – mitral regurgitation, RV – right ventricle, LV – left ventricle, LVOT – left ventricular outflow tract, PB – blood pressure, SPAP – systolic pulmonary artery pressure(1)

Fig. 3.

The usefulness of stress echo (SE) in the assessment of acquired valvular defects. The following parameters are individually assessed: valvular function alone, LV and RV function, and other hemodynamic consequences of the defect(1). MR – mitral regurgitation, MS – mitral stenosis, AR – aortic regurgitation, AS – aortic stenosis, SV – stroke volume, MPG - mean pressure gradient, PH – pulmonary hypertension
The usefulness of stress echo (SE) in the assessment of acquired valvular defects. The following parameters are individually assessed: valvular function alone, LV and RV function, and other hemodynamic consequences of the defect(1). MR – mitral regurgitation, MS – mitral stenosis, AR – aortic regurgitation, AS – aortic stenosis, SV – stroke volume, MPG - mean pressure gradient, PH – pulmonary hypertension

Threshold values of stress echo parameters associated with prognosis and treatment response_ DE – dobutamine stress echo, SE- exercise stress echo, EF – ejection fraction, SV - stroke volume, WMSI – contractility index

ParametersThreshold values
Left intraventricular obstructionLVOT gradient >50 mm Hg
Impaired functional reserve∆ WMSI <0.25 in ectatic cardiomyopathy (SE, DE)∆ EF <7.5% in NS and CRT patients (SE, DE)∆ EF <4.5% in primary MR and AR (SE)∆ Global longitudinal strain <2% in organic MR (SE)
Impaired flow reserve∆ SV <20% (DE)
Dynamic mitral regurgitation∆ EROA >13 mm2 in functional MR (SE)
Systolic pulmonary hypertensionSPAP >60 mm Hg (SE)
Limited valvular complianceMean diastolic gradient in mitral stenosis>15 mm Hg (SE); >18 mm Hg (DE)Systolic gradient in aortic stenosis >18 mm Hg (SE)
Prosthetic malfunctionMean diastolic gradient in mitral position >10 mm Hg (SE, DE)Mean systolic gradient in aortic position >20 mm Hg (SE, DE)
Functional stenosis after mitral ring plastyMean diastolic gradient >7 mm Hg
RV dysfunctionTAPSE <19 mm in limited MR (SE)

Diagnostic end-points and reasons for stress echo interruption

Diagnostic end-pointsReasons for test interruptionImproper test criteria (>1 criterion)
Maximum dobutamine dose/maximum exerciseIntolerable symptomsSymptoms: angina pectoris, dyspnea, syncope, fatigue at low stress level
Target heart rateMuscular fatigueIschemia (ST drop by >2 mm vs baseline)
Typical changes in ECGHypertension (220/120 mm Hg)New disorders of regional contractility
Typical changes in echocardiogramSymptomatic hypotension (decrease by >40 mm Hg)Arrhythmias (NSVT, SVT)
Retrosternal painArrhythmias (SVT, AF, multiple ventricular ectopic beats)Specific end-points*
DOI: https://doi.org/10.15557/jou.2019.0007 | Journal eISSN: 2451-070X | Journal ISSN: 2084-8404
Journal RSS Feed
Language: English
Page range: 49 - 53
Submitted on: Aug 15, 2018
Accepted on: Jan 30, 2019
Published on: Apr 30, 2019
Published by: MEDICAL COMMUNICATIONS Sp. z o.o.
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
stress echocardiography,
dobutamine,
exercise,
cardiac valvular defects
Related subjects:
Medicine,
Basic medical science,
Basic medical science, other

© 2019 Edyta Płońska-Gościniak, Tomasz Kukulski, Jarosław D. Kasprzak, Zbigniew Gąsior, Andrzej Szyszka, Andrzej Gackowski, Wojciech Braksator, Piotr Gościniak, Piotr Pysz, Szymon Olędzki, Wojciech Kosmala, published by MEDICAL COMMUNICATIONS Sp. z o.o.
This work is licensed under the Creative Commons Attribution 4.0 License.

Previous articleVolume 19 (2019): Issue 76 (March 2019)Next article