Diagnostic Results and Indications

Indications for stress echocardiography can be grouped into very broad categories, which eventually could encompass the overwhelming majority of patients: diagnosis of coronary artery disease; prognosis and risk stratification in patients with established diagnosis, for instance, after myocardial infarction; assessment of preoperative risk; evaluation for cardiac etiology of exertional dyspnea; evaluation after revascularization; localization of ischemia. As a rule, the less informative the exercise ECG test is, the stricter the indication for stress echocardiography is. Out of five patients, one is unable to exercise, one exercises submaximally, and one exercises maximally but the ECG is uninterpretable. The three main specific indications for pharmacological stress echocardiography can be summarized as follows: (1) patients in whom the exercise stress test is contraindicated (e.g., patients with severe arterial hypertension); (2) patients in whom the exercise stress test is not feasible (e.g., those with intermittent claudication); (3) patients in whom the exercise stress test was nondiagnostic or gave ambiguous results: inability to achieve the target heart rate response; presence of chest pain in the absence of significant electrocardiographic changes; a concomitance of conditions lowering the reliability of the ECG marker of ischemia (female sex, arterial hypertension, repolarization abnormalities on ECG under resting conditions or after hyperventilation, and need to continue drugs such as digitalis or antiarrhythmics that potentially induce ST-T changes).