Skip to main content

Advertisement

SpringerLink
Log in

Practice guidance for stress echocardiography

  • Review Article
  • Published:
Journal of Echocardiography Aims and scope Submit manuscript

Abstract

Stress echocardiography has been one of the most promising methods for the diagnosis of ischemic heart disease, hypertrophic cardiomyopathy, and pulmonary hypertension. The Japanese Society of Echocardiography produced practical guidance for the implementation of stress echocardiography in 2018. At that time, stress echocardiography was not yet widely disseminated in Japan; therefore, the 2018 practical guidance for the implementation of stress echocardiography included a report on stress echocardiography and a specific protocol to promote its use at many institutions in Japan in the future. And now, an era of renewed interest and enthusiasm surrounding the diagnosis and treatment of valvular heart disease and heart failure with preserved ejection fraction (HFpEF) has come, which are driven by emerging trans-catheter procedures and new recommended guideline-directed medical therapy. Based on the continued evidence of stress echocardiography, the new practical guideline that describes the safe and effective methodology of stress echocardiography is now created by the Guideline Development Committee of the Japanese Society of Echocardiography and is designed to expand the use of stress echocardiography for valvular heart disease and HFpEF, as well as ischemic heart disease, hypertrophic cardiomyopathy, and pulmonary hypertension. The readers are encouraged to perform stress echocardiography which will enhance the diagnosis and management of these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

The datasets are available from the corresponding author upon reasonable request.

References

  1. Daimon M, Iwano H, Onishi T, et al. Guideline from the Japanese society of echocardiography guidance for the management and maintenance of echocardiography equipment: 2022 focused update. J Echocardiogr. 2022;20:195–200.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Banerjee A, Newman DR, Van den Bruel A, et al. Diagnostic accuracy of exercise stress testing for coronary artery disease: a systematic review and meta-analysis of prospective studies. Int J Clin Pract. 2012;66:477–92.

    Article  CAS  PubMed  Google Scholar 

  3. Ryo K, Tanaka H, Kaneko A, et al. Efficacy of longitudinal speckle tracking strain in conjunction with isometric handgrip stress test for detection of ischemic myocardial segments. Echocardiography. 2012;29:411–8.

    Article  PubMed  Google Scholar 

  4. Harada Y, Utsunomiya H, Hitoshi Susawa H, et al. Determinants of exercise-induced mitral regurgitation using three-dimensional transesophageal echocardiography combined with isometric handgrip exercise. Am J Cardiol. 2021;151:78–85.

    Article  PubMed  Google Scholar 

  5. Yamada H, Oki T, Tabata T, et al. Differences in transmitral flow velocity pattern during increase in preload in patients with abnormal left ventricular relaxation. Cardiology. 1998;89:152–8.

    Article  CAS  PubMed  Google Scholar 

  6. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the European society of echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European association of echocardiography, a branch of the European society of cardiology. J Am Soc Echocardiogr. 2005;18:1440–63.

    Article  PubMed  Google Scholar 

  7. Caiati C, Lepera ME, Carretta D, et al. Head-to-head comparison of peak upright bicycle and post-treadmill echocardiography in detecting coronary artery disease: a randomized, single-blind crossover study. J Am Soc Echocardiogr. 2013;26:1434–43.

    Article  PubMed  Google Scholar 

  8. Biering-Sørensen T, Hoffmann S, Mogelvang R, et al. Myocardial strain analysis by 2-dimensional speckle tracking echocardiography improves diagnostics of coronary artery stenosis in stable angina pectoris. Circ Cardiovasc Imaging. 2014;7:58–65.

    Article  PubMed  Google Scholar 

  9. Izumi C, Eishi K, Ashihara K, et al. JCS/JSCS/JATS/JSVS 2020 Guidelines on the management of valvular heart disease. Circ J. 2020;84:2037–119.

    Article  PubMed  Google Scholar 

  10. Ohte N, Ishizu T, Izumi C, et al. JCS 2021 Guideline on the clinical application of echocardiography. Circ J. 2022;86:2045–119.

    Article  PubMed  Google Scholar 

  11. Aviles RJ, Nishimura RA, Pellikka PA, et al. A utility of stress Doppler echocardiography in patients undergoing percutaneous mitral balloon valvotomy. J Am Soc Echocardiogr. 2001;14:676–81.

    Article  CAS  PubMed  Google Scholar 

  12. Brochet E, Détaint D, Fondard O, et al. Early hemodynamic changes versus peak values: what is more useful to predict occurrence of dyspnea during stress echocardiography in patients with asymptomatic mitral stenosis? J Am Soc Echocardiogr. 2011;24:392–8.

    Article  PubMed  Google Scholar 

  13. Grimaldi A, Olivotto I, Figini F, et al. Dynamic assessment of ‘valvular reserve capacity’ in patients with rheumatic mitral stenosis. Eur Heart J Cardiovasc Imaging. 2012;13:476–82.

    Article  PubMed  Google Scholar 

  14. Magne J, Lancellotti P, Pierard LA. Exercise-induced changes in degenerative mitral regurgitation. J Am Coll Cardiol. 2010;56:300–9.

    Article  PubMed  Google Scholar 

  15. Magne J, Lancellotti P, Pierard LA. Exercise pulmonary hypertension in asymptomatic degenerative mitral regurgitation. Circulation. 2010;122:33–41.

    Article  PubMed  Google Scholar 

  16. Magne J, Mahjoub H, Dulgheru R, et al. Left ventricular contractile reserve in asymptomatic primary mitral regurgitation. Eur Heart J. 2014;35:1608–16.

    Article  CAS  PubMed  Google Scholar 

  17. Kusunose K, Popovic ZB, Motoki H, et al. Prognostic significance of exercise-induced right ventricular dysfunction in asymptomatic degenerative mitral regurgitation. Circ Cardiovasc Imaging. 2013;6:167–76.

    Article  PubMed  Google Scholar 

  18. Utsunomiya H, Hidaka T, Susawa H, et al. Exercise-stress echocardiography and effort intolerance in asymptomatic/minimally symptomatic patients with degenerative mitral regurgitation combined invasive-noninvasive hemodynamic monitoring. Circ Cardiovasc Imaging. 2018;11: e007282.

    Article  PubMed  Google Scholar 

  19. Lancellotti P, Troisfontaines P, Toussaint AC, et al. Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction. Circulation. 2003;108:1713–7.

    Article  PubMed  Google Scholar 

  20. Lancellotti P, Magne J, Dulgheru R, et al. Clinical significance of exercise pulmonary hypertension in secondary mitral regurgitation. Am J Cardiol. 2015;115:1454–61.

    Article  PubMed  Google Scholar 

  21. Rafique AM, Biner S, Ray I, et al. Meta-analysis of prognostic value of stress testing in patients with asymptomatic severe aortic stenosis. Am J Cardiol. 2009;104:972–7.

    Article  PubMed  Google Scholar 

  22. Cardim N, Galderisi M, Edvardsen T, et al. Role of multimodality cardiac imaging in the management of patients with hypertrophic cardiomyopathy: an expert consensus of the European Association of Cardiovascular Imaging Endorsed by the Saudi Heart Association. Eur Heart J Cardiovasc Imaging. 2015;16:280.

    Article  PubMed  Google Scholar 

  23. Desai MY, Bhonsale A, Patel P, et al. Exercise echocardiography in asymptomatic HCM: exercise capacity, and not Lvoutflow tract gradient predicts long-term outcomes. JACC Cardiovasc Imaging. 2014;7:26–36.

    Article  PubMed  Google Scholar 

  24. Ishiyama M, Sugiura E, Ito H, et al. Refractory exercise-induced severe mitral regurgitation in a patient with hypertrophic cardiomyopathy. J Echocardiogr. 2023;21:40–1.

    Article  PubMed  Google Scholar 

  25. Obokata M, Kane GC, Reddy YN, et al. Role of diastolic stress testing in the evaluation for heart failure with preserved ejection fraction: a simultaneous invasive-echocardiographic study. Circulation. 2017;135:825–38.

    Article  PubMed  Google Scholar 

  26. Kane GC, Sachdev A, Villarraga HR, et al. Impact of age on pulmonary artery systolic pressures at rest and with exercise. Echo Res Pract. 2016;3:53–61.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lewis GD, Bossone E, Naeije R, et al. Pulmonary vascular hemodynamic response to exercise in cardiopulmonary diseases. Circulation. 2013;128(1470–9):58.

    Google Scholar 

  28. Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43:3618–731.

    Article  CAS  PubMed  Google Scholar 

  29. Bossone E, D’Andrea A, D’Alto M, et al. Echocardiography in pulmonary arterial hypertension: from diagnosis to prognosis. J Am Soc Echocardiogr. 2013;26:1–14.

    Article  PubMed  Google Scholar 

  30. Lancellotti P, Magne J, Donal E, et al. Determinants and prognostic significance of exercise pulmonary hypertension in asymptomatic severe aortic stenosis. Circulation. 2012;126:851–9.

    Article  PubMed  Google Scholar 

  31. Borlaug BA, Nishimura RA, Sorajja P, et al. Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction. Circ Heart Fail. 2010;3:588–95.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Shim CY, Kim SA, Choi D, et al. Clinical outcomes of exercise-induced pulmonary hypertension in subjects with preserved left ventricular ejection fraction: implication of an increase in left ventricular filling pressure during exercise. Heart. 2011;97:1417–24.

    Article  PubMed  Google Scholar 

  33. Kusunose K, Yamada H, Hotchi J, et al. Prediction of future overt pulmonary hypertension by 6-min walk stress echocardiography in patients with Connective tissue disease. J Am Coll Cardiol. 2015;66:376–84.

    Article  PubMed  Google Scholar 

  34. Kane GC, Hepinstall MJ, Kidd GM, et al. Safety of stress echocardiography supervised by registered nurses: results of a 2-year audit of 15,404 patients. J Am Soc Echocardiogr. 2008;21:337–41.

    Article  PubMed  Google Scholar 

  35. Geleijnse ML, Krenning BJ, Nemes A, et al. Incidence, pathophysiology, and treatment of complications during dobutamine-atropine stress echocardiography. Circulation. 2010;121:1756–67.

    Article  PubMed  Google Scholar 

  36. Lancellotti P, Pellikka PA, Budts W, et al. The clinical use of stress echocardiography in non ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging. 2016;17:1191–229.

    Article  PubMed  Google Scholar 

  37. Pibarot P, Dumesnil JG. New concepts in valvular hemodynamics: implications for diagnosis and treatment of aortic stenosis. Can J Cardiol. 2007;23:40B-47B.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Reviewers: This document was supervised and edited by the Guideline Committee of the Japanese Society of Echocardiography. Chair: Chisato Izumi, Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center. Vice Chair: Masao Daimon, Department of Cardiovascular Medicine, International University of Health and Welfare Mita Hospital. Committee membersHiroyuki Iwano, Department of Cardiology, Teine Keijinkai Hospital. Hiromi Umeda, Department of Laboratory Technicians, Heisei Shisenkai Kokura Kinen Hospital. Tetsuari Ohnishi, Department of Cardiovascular Medicine, Hyogo Prefectural Harima-Himeji General Medical Center. Takahiro Ohara, Division of Geriatric and Community Medicine, Tohoku Medical and Pharmaceutical University. Hidekazu Tanaka, Division of Cardiovascular Medicine, Kobe University School of Medicine. Hirotsugu Yamada, Division of Community Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences.

Author information

Authors and Affiliations

  1. Faculty of Medicine, Center for Medical Education and Clinical Training, Kindai University, 377-2 Ohnohigasi, Osakasayama, Osaka, 589-8511, Japan

    Yutaka Hirano

  2. Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, 5‑7‑1 Fujishiro‑dai, Suita Osaka, 565‑8565, Japan

    Masashi Amano

  3. Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan

    Masaru Obokata

  4. Department of Cardiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan

    Masaki Izumo

  5. Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan

    Hiroto Utsunomiya

Authors
  1. Yutaka Hirano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masashi Amano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masaru Obokata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masaki Izumo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroto Utsunomiya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yutaka Hirano.

Ethics declarations

Conflicts of interests

Dr. Izumo is a clinical proctor of Abbott Medical Japan and a screening proctor of Edwards Lifesciences. Dr. Utsunomiya is an advisor and clinical proctor of Abbott Medical Japan, and is a speaker honoraria from Bayer Yakuhin, Ono Pharmaceutical, AstraZeneca, and Bristol Myers Squibb. Dr. Obokata received research grants from Nippon Boehringer-Ingelheim and AMI Inc. and speaker honoraria from Novartis, Otsuka Pharmaceutical, Eli Lilly, AstraZeneca, and Nippon Boehringer-Ingelheim. The other authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Outside evaluators

This document was supervised and edited by Outside evaluators. Masaaki Takeuchi, Department of Laboratory Testing Blood Transfusion, University of Occupational and Environmental Health. Yoshihiro Seo, Department of Cardiology, Nagoya City University.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hirano, Y., Amano, M., Obokata, M. et al. Practice guidance for stress echocardiography. J Echocardiogr 22, 1–15 (2024). https://doi.org/10.1007/s12574-024-00643-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12574-024-00643-1

Keywords

Search

Navigation