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Echocardiographic Signs of Ischemia

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Stress Echocardiography

Abstract

The response of left ventricular function to ischemia is monotonous and independent of the employed stress [1]. The same echocardiographic signs can be found in transient ischemia and acute infarction. The difference is in the time sequence, and from an echocardiographic viewpoint myocardial ischemia is a “reversible” myocardial infarction.

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References

  1. Falsetti HL, Marcus ML, Kerber RE et al (1981) Quantification of myocardial ischemia and infarction by left ventricular imaging. Circulation 63:747–51

    Article  PubMed  CAS  Google Scholar 

  2. Pandian NG, Skorton DJ, Collins SM et al (1983) Heterogeneity of left ventricular segmental wall thickening and excursion in 2-dimensional echocardiograms of normal human subjects. Am J Cardiol 51:1667–73

    Article  PubMed  CAS  Google Scholar 

  3. Arnese M, Fioretti PM, Cornel JH, et al (1994) Akinesis becoming dyskinesis during high-dose dobutamine stress echocardiography: a marker of myocardial ischemia or a mechanical phenomenon? Am J Cardiol 73:896–899

    Article  PubMed  CAS  Google Scholar 

  4. Chen C, Li L, Chen LL, et al (1995) Incremental doses of dobutamine induce a biphasic response in dysfunctional left ventricular regions subtending coronary stenoses. Circulation 92:756–766

    Article  PubMed  CAS  Google Scholar 

  5. Gibbons RJ, Chatterjee K, Daley J, et al (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). J Am Coll Cardiol 33:2092–2197

    Article  PubMed  CAS  Google Scholar 

  6. Sheikh KH, Bengtson JR, Helmy S, et al (1990) Relation of quantitative coronary lesion measurements to the development of exercise-induced ischemia assessed by exercise echocardiography. J Am Coll Cardiol 15:1043–1051

    Article  PubMed  CAS  Google Scholar 

  7. Picano E, Parodi O, Lattanzi F, et al (1989) Comparison of dipyridamole-echocardiography test and exercise thallium-201 scanning for diagnosis of coronary artery disease. Am J Noninvasive Cardiol 3:85–92

    Google Scholar 

  8. Cortigiani L, Picano E, Landi P, et al (1998) Value of pharmacologic stress echocardiography in risk stratification of patients with single-vessel disease: a report from the Echo-Persantine and Echo-Dobutamine International Cooperative Studies. J Am Coll Cardiol 32:69–74

    Article  PubMed  CAS  Google Scholar 

  9. Lattanzi F, Picano E, Bolognese L, et al (1991) Inhibition of dipyridamole-induced ischemia by antianginal therapy in humans. Correlation with exercise electrocardiography. Circulation 83:1256–1262

    Article  PubMed  CAS  Google Scholar 

  10. Ferrara N, Longobardi G, Nicolino A, et al (1992) Effect of beta-adrenoceptor blockade on dipyridamole-induced myocardial asynergies in coronary artery disease. Am J Cardiol 70:724–727

    Article  PubMed  CAS  Google Scholar 

  11. Dodi C, Pingitore A, Sicari R, et al (1997) Effects of antianginal therapy with a calcium antagonist and nitrates on dobutamine-atropine stress echocardiography. Comparison with exercise electrocardiography. Eur Heart J 18:242–247

    Article  PubMed  CAS  Google Scholar 

  12. San Roman JA, Vilacosta I, Castillo JA, et al (1996) Dipyridamole and dobutamine-atropine stress echocardiography in the diagnosis of coronary artery disease. Comparison with exercise stress test, analysis of agreement, and impact of antianginal treatment. Chest 110:1248–1254

    Article  PubMed  CAS  Google Scholar 

  13. Nagel E, Lehmkuhl HB, Bocksch W, et al (1999) Noninvasive diagnosis of ischemia-induced wall motion abnormalities with the use of high-dose dobutamine stress MRI: comparison with dobutamine stress echocardiography. Circulation 99:763–770

    Article  PubMed  CAS  Google Scholar 

  14. Specchia G, Servi S de, Falcone C, et al (1981) Significance of exercise-induced ST-segment elevation in patients without myocardial infarction. Circulation. 63:46–53

    Article  PubMed  CAS  Google Scholar 

  15. Kawano H, Fuji H (1995) Induction of coronary spasm during dobutamine stress echocardiography. Circulation 92:1–89

    Article  Google Scholar 

  16. Varga A, Cortigiani L, Rossi PC, et al (1999) Coronary vasospasm as a source of false positive results during dobutamine echocardiography. Cardiologia 44:907–912

    PubMed  CAS  Google Scholar 

  17. Picano E, Lattanzi F, Masini M, et al (1988) Aminophylline termination of dipyridamole stress as a trigger of coronary vasospasm in variant angina. Am J Cardiol 62: 694–697

    Article  PubMed  CAS  Google Scholar 

  18. Spes CH, Mudra H, Schnaack SD, et al (1996) Dobutamine stress echocardiography for noninvasive diagnosis of cardiac allograft vasculopathy: a comparison with angiography and intravascular ultrasound. Am J Cardiol 78:168–174

    Article  PubMed  CAS  Google Scholar 

  19. Franchini M, Traversi E, Cannizzaro G, et al (2000) Dobutamine stress echocardiography and thallium-201 SPECT for detecting ischaemic dilated cardiomyopathy in patients with heart failure. Eur J Echocardiogr 1:109–115

    Article  PubMed  CAS  Google Scholar 

  20. Bach DS, Muller DW, Gros BJ, et al (1994) False positive dobutamine stress echocardiograms: characterization of clinical, echocardiographic and angiographic findings. J Am Coll Cardiol 24:928–933

    Article  PubMed  CAS  Google Scholar 

  21. Baroni M, Maffei S, Terrazzi M, et al (1996) Mechanisms of regional ischaemic changes during dipyridamole echocardiography in patients with severe aortic valve stenosis and normal coronary arteries. Heart 75:492–497

    Article  PubMed  CAS  Google Scholar 

  22. Picano E, Palinkas A, Amyot R (2001) Diagnosis of myocardial ischemia in hypertensive patients. J Hypertens 19:1177–1183

    Article  PubMed  CAS  Google Scholar 

  23. Rajappan K, Rimoldi OE, Dutka DP, et al (2002) Mechanisms of coronary microcirculatory dysfunction in patients with aortic stenosis and angiographically normal coronary arteries. Circulation 105:470–476

    Article  PubMed  Google Scholar 

  24. Ha JW, Juracan EM, Mahoney DW, et al (2002) Hypertensive response to exercise: a potential cause for new wall motion abnormality in the absence of coronary artery disease. J Am Coll Cardiol 39:323–327

    Article  PubMed  Google Scholar 

  25. Beker B, Vered Z, Bloom NV, et al (1994) Decreased thickening of normal myocardium with transient increased wall thickness during stress echocardiography with atrial pacing. J Am Soc Echocardiogr 7:381–387

    PubMed  CAS  Google Scholar 

  26. Hirshleifer J, Crawford M, O’Rourke RA, et al (1975) Influence of acute alterations in heart rate and systemic arterial pressure on echocardiographic measures of left ventricular performance in normal human subjects. Circulation 52:835–841

    Article  PubMed  CAS  Google Scholar 

  27. Borges AC, Pingitore A, Cordovil A, et al (1995) Heterogeneity of left ventricular regional wall thickening following dobutamine infusion in normal human subjects. Eur Heart J 16:1726–1730

    PubMed  CAS  Google Scholar 

  28. Carstensen S, Ali SM, Stensgaard-Hansen FV, et al (1995) Dobutamine-atropine stress echocardiography in asymptomatic healthy individuals. The relativity of stress-induced hyperkinesia. Circulation 92:3453–3463

    Article  PubMed  CAS  Google Scholar 

  29. Bigi R, Cortigiani L, Bax JJ et al (2002) Stress echocardiography for risk stratification of patients with chest pain and normal or slightly narrowed coronary arteries. J Am Soc Echocardiogr 15:1285–9

    Article  PubMed  Google Scholar 

  30. Olson CE, Porter TR, Deligonul U, et al (1994) Left ventricular volume changes during dobutamine stress echocardiography identify patients with more extensive coronary artery disease. J Am Coll Cardiol 24:1268–1273

    Article  PubMed  CAS  Google Scholar 

  31. Yamashita K, Takeuchi M, Tsuda Y, et al (2000) Does the lack of hyperkinesis during dobutamine stress echocardiography predict the functional significance of coronary arterial stenosis? Echocardiography 17:229–239

    Article  PubMed  CAS  Google Scholar 

  32. Harrison MR, Smith MD, Friedman BJ, et al (1987) Uses and limitations of exercise Doppler echocardiography in the diagnosis of ischemic heart disease. J Am Coll Cardiol 10:809–817

    Article  PubMed  CAS  Google Scholar 

  33. Bryg RJ, Labovitz AJ, Mehdirad AA, et al (1986) Effect of coronary artery disease on Doppler-derived parameters of aortic flow during upright exercise. Am J Cardiol 58:14–19

    Article  PubMed  CAS  Google Scholar 

  34. Agati L, Arata L, Neja CP, et al (1990) Usefulness of the dipyridamole-Doppler test for diagnosis of coronary artery disease. Am J Cardiol 65: 829–834

    Article  PubMed  CAS  Google Scholar 

  35. el-Said ES, Roelandt JR, Fioretti PM, et al (1994) Abnormal left ventricular early diastolic filling during dobutamine stress Doppler echocardiography is a sensitive indicator of significant coronary artery disease. J Am Coll Cardiol 24:1618–1624

    Article  PubMed  CAS  Google Scholar 

  36. Lattanzi F, Picano E, Masini M, et al (1989) Transmitral flow changes during dipyridamole-induced ischemia. A Doppler-echocardiographic study. Chest 95:1037–1042

    Article  PubMed  CAS  Google Scholar 

  37. Nishimura RA, Housmans PR, Hatle LK, et al (1989) Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. Part I. Physiologic and pathophysiologic features. Mayo Clin Proc 64:71–81

    Article  PubMed  CAS  Google Scholar 

  38. Mazeika PK, Nadazdin A, Oakley CM (1992) Stress Doppler echocardiography using dobutamine in coronary patients with and without ischaemia induction. Eur Heart J 13:1020–1027

    PubMed  CAS  Google Scholar 

  39. Kaul S, Pearlman JD, Touchstone DA, et al (1989) Prevalence and mechanisms of mitral regurgitation in the absence of intrinsic abnormalities of the mitral leaflets. Am Heart J 118:963–972

    Article  PubMed  CAS  Google Scholar 

  40. Zachariah ZP, Hsiung MC, Nanda NC, et al (1987) Color Doppler assessment of mitral regurgitation induced by supine exercise in patients with coronary artery disease. Am J Cardiol 59:1266–1270

    Article  PubMed  CAS  Google Scholar 

  41. Marwick TH (2003) Stress echocardiography. Heart 89:113–118

    Article  PubMed  Google Scholar 

  42. McKinley JB (1981) From promising report to standard procedure: seven stages in the career of a medical innovation. Milbank Mem Fund Q 59:374–411

    Article  Google Scholar 

  43. Colombo F (1996) A warning from the Internet: our freedom is at risk. La Repubblica, 8 January

    Google Scholar 

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Picano, E. (2003). Echocardiographic Signs of Ischemia. In: Stress Echocardiography. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-05096-5_5

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  • DOI: https://doi.org/10.1007/978-3-662-05096-5_5

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-05098-9

  • Online ISBN: 978-3-662-05096-5

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