When a stress echocardiography test result is positive, myocardial ischemia is present. The presence of regional dysfunction requires ischemia, and – in the words of John Ross Jr. – the very definition of ischemia requires an alteration of myocardial function: “Ischemia is a reduction in myocardial blood flow sufficient to cause a decrease in myocardial contraction.” In this definition, however, one must consider that “decrease in myocardial contraction” is not synonymous with “reduction in visually assessed regional systolic thickening,” which expresses only one dimension (radial strain) of the complex three-dimensional event of myocardial contraction. The latter also includes circumferential and longitudinal strain, all contributing to changes in ejection fraction and to the pump function. In addition, systolic thickening is evaluated in a subjective and qualitative, not objective and quantitative, way and reflects the average transmural function, without discriminating between the subendocardium (highly vulnerable to ischemia) and subepicardium (more resistant to ischemia). The clinical world is not the experimental laboratory, stress echocardiography is not equivalent to implanted sonomicrometry, and therefore the fundamental parameter of regional systolic thickening on two-dimensional echocardiography should be integrated with information derived from clinical presentation, patient specificity, and information provided by other markers of ischemia.
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References
Hearse DJ (1994) Myocardial ischemia: can we agree on a definition for the 21st century? Cardiovasc Res 28:1737–1744
Ross J Jr (1986) Assessment of ischemic regional myocardial dysfunction and its reversibility. Circulation 74:1186–1190
Bogaert J, Rademakers FE (2001) Regional nonuniformity of normal adult human left ventricle. Am J Physiol Heart Circ Physiol 280:H610–H620
Stein PD, Marzilli M, Sabbah HN, et al (1980) Systolic and diastolic pressure gradients within the left ventricular wall. Am J Physiol 238:H625–H630
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
Gomes JA, Damato AN, Akhtar M, et al (1977) Ventricular septal motion and left ventricular dimensions during abnormal ventricular activation. Am J Cardiol 39:641–650
Myers JH, Stirling MC, Choy M, et al (1986). Direct measurement of inner and outer wall thickening dynamics with epicardial echocardiography. Circulation 74:164–172
Kaul S (1990) Echocardiography in coronary artery disease. Curr Probl Cardiol 15:233–298
Armstrong WF (1988) Echocardiography in coronary artery disease. Prog Cardiovasc Dis 30:267–288
Mondillo S, Galderisi M, Ballo P, Study Group of Echocardiography of the Italian Society of Cardiology, et al (2006) Left ventricular systolic longitudinal function: comparison among simple M-mode, pulsed, and M-mode color tissue Doppler of mitral annulus in healthy individuals. J Am Soc Echocardiogr 19:1085–1091
Reant P, Labrousse L, Lafitte S, et al (2008) Experimental validation of circumferential, longitudinal, and radial 2-dimensional strain during dobutamine stress echocardiography in ischemic conditions. J Am Coll Cardiol. 51:149–157
Braunwald E, Kloner RA (1982) The stunned myocardium: prolonged, postischemic ventricular dysfunction. Circulation 66:1146–1149
Braunwald E, Rutherford JD (1986) Reversible ischemic left ventricular dysfunction: evidence for the “hibernating myocardium”. J Am Coll Cardiol 8:1467–1470
Vanoverschelde JL, Melin JA (2001) The pathophysiology of myocardial hibernation: current controversies and future directions. Prog Cardiovasc Dis 43:387–398
Pierard LA, De Landsheere CM, Berthe C, et al (1990) Identification of viable myocardium by echocardiography during dobutamine infusion in patients with myocardial infarction after thrombolytic therapy: comparison with positron emission tomography. J Am Coll Cardiol 15:1021–1031
Lieberman AN, Weiss JL, Jugdutt BI, et al (1981) Two-dimensional echocardiography and infarct size: relationship of regional wall motion and thickening to the extent of myocardial infarction in the dog. Circulation 63:739–746
Carpeggiani C, L'Abbate A, Marzullo P, et al (1989) Multiparametric approach to diagnosis of non-Q-wave acute myocardial infarction. Am J Cardiol 63:404–408
Gardin JM, Adams DB, Douglas PS et al, on behalf of American Society of Echocardiography (2002) Recommendations for a standardized report for adult transthoracic echocardiography: a report from the American Society of Echocardiography's Nomenclature and Standards Committee and Task Force for a Standardized Echocardiography Report. J Am Soc Echocardiogr 15:275–290
Little WC, Reeves RC, Arciniegas J, et al (1982) Mechanism of abnormal interventricular septal motion during delayed left ventricular activation. Circulation 65:1486–1491
De Castro S, Pandian NG (eds) (2000) Manual of clinical echocardiography. Time-Science
Geleijnse ML, Vigna C, Kasprzak JD, et al (2000) Usefulness and limitations of dobutamine atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block.A multicentre study. Eur Heart J 21:1666–1673
Stojnic BB, Stojanov PL, Angelkov L, et al (1996) Evaluation of asynchronous left ventricular relaxation by Doppler echocardiography during ventricular pacing with AV synchrony (VDD): comparison with atrial pacing (AAI). Pacing Clin Electrophysiol 19:940–944
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
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
Carstensen S, Ali SM, Stensgaard-Hansen FV, et al (1995) Dobutamine-atropine stress echocar-diography in asymptomatic healthy individuals. The relativity of stress-induced hyperkinesia. Circulation 92:3453–3463
Distante A, Picano E, Moscarelli E, et al (1985) Echocardiographic versus hemodynamic monitorino during attacks of variant angina pectoris. Am J Cardiol 55:1319–1322
Pellikka PA, Nagueh S F, Elhendy AA, et al; American Society of Echocardiography (2007). American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr. 20:1021–1041
Sicari R, Nihoyannopoulos P, Evangelista A, et al (2008). Stress echocardiography consensus statement of the European Association of Echocardiography. Eur J Echocardiogr 9:415–437
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Recchia, F., Picano, E. (2009). Rational Basis of Stress Echocardiography. In: Picano, E. (eds) Stress Echocardiography. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-76466-3_4
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