Editorial Reviews. Review. From reviews of the previous editions: “Dr. Picano, one of the Buy Stress Echocardiography: Read 1 Books Reviews – Amazon. com. The new clinical standard of integrated quadruple stress echocardiography with ABCD protocol. Eugenio Picano, corresponding author. Eugenio Picano, corresponding author 1 Sabrina .. Picano E. Stress echocardiography: from pathophysiological toy to diagnostic tool. Point of.
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The cardinal sign of transient myocardial ischemia is a stress-induced regional asynergy also called dyssynergy in its three degrees: The integration of 4 different variables into a single one-stop shop expands the risk stratification potential of SE. Discussion When state-of-the art protocols are considered, dipyridamole and dobutamine stress echo have similar accuracy, and — most importantly — the same sensitivity for detection of CAD. However, hibernating and stunned segments have some residual coronary vasodilatory reserve, which is mirrored by contractile reserve.
For recognition of myocardial viability, both tests have similar diagnostic and prognostic value [ 5960 ], but the wealth of data clearly favors low dose dobutamine, which is currently the only stress echo test with this class 1 indication for viability assessment in guidelines [ 56 ]. We also calculated the pooled values of sensitivity, specificity and accuracy weighted for sample size with fixed effect model Comprehensive Meta-Analysis program — Biostat Englewood, NJ.
Stress Echocardiography : Eugenio Picano :
Prognostic value of coronary flow reserve in asymptomatic moderate or severe aortic stenosis with preserved ejection fraction and nonobstructed coronary arteries.
Diagnostic and prognostic value of dipyridamole and dobutamine stress echocardiography in patients with Q-wave acute myocardial infarction. When state-of-the art protocols are considered, dipyridamole and dobutamine stress echo have similar accuracy, specificity and — most importantly — sensitivity for detection of CAD.
Pharmacological stress echocardiography in the diagnosis of coronary artery disease and myocardial ischemia: Coronary microvascular dysfunction and future risk of heart failure with preserved ejection fraction. Dipyridamole acts through accumulation of endogenous adenosine, which is a key retaliatory metabolite [ 46 ] with a variety of anti-ischemic and cardioprotective effects [ 47 – 49 ] — but too much of a good thing can be dangerous [ 50 ].
In addition to the universal IQ-SE protocol, other parameters can be added in special subsets.
Accuracy values for individual studies and cumulative analysis. This article has been cited by other articles in PMC. The inclusion criteria for this meta-analysis were:. The strategy centered on functional imaging with SE for prognostic stratification minimizes the radiation exposure associated with an anatomy-first approach by CT coronary angiography complemented by functional testing with scintigraphy, which frequently reaches cumulative exposures in the range of chest X-rays per patient and sometimes per exam as shown in the Radio-EVINCI international trial [ 23 ].
B-lines during stress are detectable in the majority of patients with HF and either reduced [ 42 ] and preserved ejection fraction EF [ 43 ], and may also appear in CAD patients during physical or pharmacological stress [ 44 ].
The limited value of RWMA outside CAD The population of patients arriving to the SE lab is changing, with a eugennio percentage of patients with HF, valvular heart disease, adult congenital heart disease, pulmonary hypertension, extreme physiology [ 33 ].
RWMA are linked to stress-induced subendocardial hypoperfusion, usually caused by a critical reduction in coronary flow reserve due to an anatomically and physiologically significant epicardial artery stenosis [ 1 ]. The possibility echocardiotraphy recruiting the inotropic reserve might appear paradoxical in the presence of hibernation or stunning. Risk stratification of SE results beyond regional wall motion abnormalities The integration of 4 different variables into a single one-stop shop expands the risk stratification potential of SE.
Simple six-item risk score improves risk prediction capability of stress echocardiography. Life-threatening complications occur in 1 out of patients with high dose dipyridamole and 1 in with dobutamine [ 4950 ]. Temporal trends in the utilization of noninvasive diagnostic tests for coronary artery disease in Ontario between and Eygenio echo applications beyond coronary artery disease. LVCR is highly feasible during all forms of stress: Stress echocardiography expert consensus statement.
Pulmonary hypertension and pulmonary artery acceleration time: Conclusion The recent ESC [ 5 ] guidelines on stable angina and EAE recommendations on stress ecnocardiography [ 61 ] are evidence-based in concluding that “dobutamine and vasodilators at appropriately high doses are equally potent ischemic stressors for inducing wall abnormalities in presence of a critical coronary artery stenosis.
The increase in coronary blood flow during hyperemia can be conceptually associated with changes in the local myocardial temperature. Cost-effectiveness of a management strategy based on exercise echocardiography versus exercise electrocardiography strese patients presenting with suspected angina during long term follow up: The emerging role of exercise testing and stress echocardiography in valvular heart disease.
Other aspects of the test are at least equally important and include the prognostic value, the safety, the feasibility rate, echocardiogrsphy quality of echocardiographic imaging and the capability to recognize myocardial viability. strexs
In Ontario, Canada, from to the utilization rate of stress scintigraphy decreased at a mean annual rate of – 1. Specificity values in individual studies and echocardiogrphy analysis. The hazards of scoring the quality of clinical trials for meta-analysis.
The operator-dependence can be minimized – not abolished – by expert training and adoption of conservative reading criteria, with credentialing via standardized web-based training and certification [ 29 ]. It is the least feasible and the more technically demanding of the new parameters: After limiting to human studies we identified 86 citations. There are extensive data in the literature that the prognostic accuracy of the 2 tests is very similar [ 28295455 ], whereas the number of minor, but limiting, and major life-threatening complications is about 2 times higher with dobutamine than with dipyridamole [ 56 – 58 ].
Inappropriate testing is a waste of public health money and also lowers the diagnostic and prognostic value of SE [ 11 — 13 ]. The inclusion criteria for this meta-analysis were: J Am Coll Cardiol.
The new clinical standard of integrated quadruple stress echocardiography with ABCD protocol
Other parameters may be more feasible and possibly more useful during stress, such as acceleration time of pulmonary flow and B-lines. Pucano and the road to sustainability The prescription of a single individual cardiac stress imaging test has a large economic, environmental and public health impact since around 10 million stress cardiac imaging test are performed each year in USA only.
Picano E, Scali MC. The ABCD parameters are conceptually merged, temporally synchronized, and methodologically harmonized in the new standard adopted in SE study: