Past, Present and Future of Stress Echocardiography - How Far Have We Come and How Far Can We Go?

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Citation
Asia Pacific Cardiology - Volume 2 Issue 1;2008:2(1):53-55

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How Far Have We Come?

Cardiac imaging using ultrasound (so-called ‘echocardiography’) was introduced more than 50 years ago. Resting echocardiographic detection of myocardial infarction was described as the reduction in regional contractile function,1 and the development of stress echocardiography in the early era was recognised after the introduction of 2D echocardiographic imaging. The initial report in 1979 by Wann et al. demonstrated the value of 2D echocardiography in identifying exercise-induced wall motion abnormalities.2 During the early days of stress echocardiography, problems included imaging quality and techniques. For evaluating patients with known or suspected coronary artery disease (CAD), there was also the need to establish equivalent accuracy and prognostic values to the well-established alternative imaging technique, stress radionuclide myocardial perfusion imaging. The acquisition of stress echocardiographic imaging initially involved continuous videotape recording for sequential evaluation of wall motion; the development of the digital acquisition system for the side-by- side comparison of rest and post-stress imaging was a major advance.
Early studies of stress echocardiography employed exercise as a stressor and were mostly feasibility studies.2–4 Any form of physical exercise that provides an appropriate increase in heart rate and cardiovascular workload can be used in the performance of exercise echocardiography. However, the technique of exercise echocardiography is challenging in terms of image acquisition during physical exercise (either on a treadmill or a bicycle). Furthermore, the feasibility of exercise echocardiography is limited in patients who are unable or unwilling to exercise, or when myocardial viability is an important issue. This led to the development of various forms of pharmacological and other non-exercise stressors (see Table 1).
The advent of offline digital handling for data acquisition, storage and display, further improvements in echocardiographic imaging techniques and the development of a wide variety of stressor modalities contributed to rapid growth in the field of stress echocardiography.

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