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Grading of Ischemic Response in Stress Echocardiography

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Stress Echocardiography

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Abstract

A dichotomous (yes or no) classification of the results of both provocative tests (positive and negative) and coronary angiography (disease present or absent) in conventional sensitivity/specificity analysis of test results has at least three important limitations. Coronary artery disease is not an all or none condition: a binary classification requires arbitrary threshold criteria and creates artificial distinctions in coronary artery disease, which, in actuality, shows a continuum spectrum of severity [1]. Sensitivity and specificity values tend to be affected by the disease distribution in the study population: a sample distribution with a high frequency of mild disease will be placed centrally near the threshold values, where scatter is more likely to lower sensitivity and specificity [2]. Percentage of diameter narrowing is not an adequate standard to quantifying stenosis severity in clinical studies [3]: in unselected populations, this anatomic parameter has a poor correlation with the coronary flow reserve (see Chap. 3). Thus, coronary artery disease is a complex phenomenon which cannot be described adequately by means of a simple “normality vs disease” code; there are, in fact, significant differences as regards the degree and the extent of coronary artery disease, carrying important implications for both the therapeutic and the prognostic side. A stress test should then not only predict the presence/absence of coronary disease, but also stratify the disease severity. Accordingly, the diagnosis of myocardial ischemia by stress echocardiography should be delimited by time/space coordinates which represent: the circumferential (horizontal) extent of ischemia (x axis); the transmural (vertical) depth of ischemia (y axis); the ischemia-free stress time (i.e., the time from the start of the stress to the appearance of ischemia) (z axis) (Fig. 1).

“If time and space, as sages say/are things that cannot be the butterfly that lives a day/has lived as long as we ... ... but time is time, and passes by/though sages disagree”

T. S. Eliot, Song

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  1. Institute of Clinical Physiology, CNR, Via Paolo Savi, 8, I-56100, Pisa, Italy

    Dr. Eugenio Picano

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© 1994 Springer-Verlag Berlin Heidelberg

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Picano, E. (1994). Grading of Ischemic Response in Stress Echocardiography. In: Stress Echocardiography. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-02979-4_9

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  • DOI: https://doi.org/10.1007/978-3-662-02979-4_9

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-02981-7

  • Online ISBN: 978-3-662-02979-4

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