The use of exercise and pharmacologic stress echocardiography for both diagnostic and prognostic assessment of patients with known or suspected coronary artery disease continues on a course of rapid expansion in the latter half of the 1990s. As Dr. Brown notes in his review of the diagnostic and prognostic utility of noninvasive imaging, stress echocardiography is a relatively young technique compared with myocardial perfusion imaging employing nuclear agents (1). The first investigations of exercise echocardiography as a diagnostic technique were conducted in the late 1970s and early 1980s, but in this country, widespread use of the technique outside of specialized centers did not take place until the early 1990s. The dissemination of stress echocardiography to community hospital and private practice settings has been encouraged by a proliferation of studies demonstrating both the diagnostic and prognostic value of the technique. Dr. Brown has included some of these studies in his review in which he raises several concerns about the value of stress echocardiography relative to myocardial perfusion imaging, including: a lower sensitivity of stress echocardiography for single vessel disease; insensitivity of echocardiography for jeopardized, viable myocardium and peri-infarction ischemia; and inability of the test to distinguish patients at low risk for cardiac events. In this brief commentary, each issue will be addressed from the standpoint of an investigator of stress echocardiography and a clinician who uses both echocardiographic and myocardial perfusion imaging for assessment of patients.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine