Stress Echocardiography

Stress echocardiography is a complex topic due to the various modalities (e.g. dynamic and pharmacological stress echocardiography). The individual acoustic window and the patients' comorbidities play an essential role in choosing the optimal diagnostic modality. Adequate technical ultrasound systems as well as all equipments to treat acute cardiovascular events including resuscitation and ventilatory assistance need to be provided when performing stress echocardiography. The investigator should be experienced in all modalities of transthoracic echocardiography - especially in image acquisition under suboptimal conditions and image optimization - and should be trained in stress echocardiography regarding indications, contraindications, termination criteria and data analysis and interpretation of the acquired data sets. The most frequent indication of stress echocardiography is the detection of ischemia or myocardial viability followed by special indications in patients with suspected hypertrophic cardiomyopathy, (asymptomatic) valvular heart diseases etc. With respect to the individual problem of the patient the planning of specific stress protocols is a fundamental prerequisite to ensure the optimal diagnostic value of the procedure. The diagnostic and prognostic value of stress echocardiography is comparably high provided that stress echocardiography will be performed by an experienced investigator, because this modality requires plenty of practical skills and a lot of methodological and clinical expertise.