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Step C for Cardiac Reserve in Stress Echocardiography

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Stress Echocardiography

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Abstract

Quantitative measurements of end-diastolic volume and end-systolic volume are not routinely employed in many laboratories since they are time-consuming and not so reproducible for image degradation during stress. Ejection fraction is usually accurately estimated by eyeballing, but the measurement of left ventricular volumes requires a quantitative assessment with endocardial border delineation of left ventricular planimetry by hand. The method of disks requires biplane apical views, which are feasible and of good quality in most but not all patients. Simpler methods are less accurate for absolute measurements, but equally accurate for the evaluation of relative changes from rest to peak stress. When the Simpson method is not feasible, apical single plane or even, in non-distorted ventricles, the simplest linear method can be employed. As technology evolves allowing high frame rates during stress, volumetric stress echo will become routine with real-time three-dimensional echocardiography, independent of geometric assumptions. Artificial intelligence allows operator-independent, click-free, assessment of left ventricular volume from 2D images. End-diastolic volume and end-systolic volume explore the mechanisms of reduced preload and reduced contractile reserve. Ejection fraction should not be considered a measure of contractility, and meaningful use of ejection fraction as a diagnostic parameter requires simultaneous estimation of left ventricular volumes. A normal cardiac reserve implies a normal chronotropic reserve, preload reserve (with end-diastolic volume higher during stress than at rest), and a normal contractile reserve (with end-systolic volume lower during stress compared to rest). A reduced cardiac reserve and inducible regional wall motion abnormalities have independent and incremental value in predicting outcomes.

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Acknowledgments

The authors would like to acknowledge the contribution of Dr. Maasaki Tacheuchi to the previous editions of this chapter.

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Authors and Affiliations

  1. Clinic of Cardiovascular Diseases, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina

    Tonino Bombardini

  2. Institute of Clinical Physiology of the National Research Council, Pisa, Italy

    Eugenio Picano

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  1. Tonino Bombardini
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  1. Institute of Clinical Physiology of the National Research Council, Pisa, Italy

    Eugenio Picano

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Bombardini, T., Picano, E. (2023). Step C for Cardiac Reserve in Stress Echocardiography. In: Picano, E. (eds) Stress Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-031-31062-1_3

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  • DOI: https://doi.org/10.1007/978-3-031-31062-1_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-31061-4

  • Online ISBN: 978-3-031-31062-1

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