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• Exercise echocardiography
  Gareth J. Wynn
  Published on: 27 January 2008

• Published on: 27 January 2008

  Exercise echocardiography

  • Gareth J. Wynn, Clinical Fellow
  • Other Contributors:
    • Malcolm I. Burgess

  Dear Editor,

  The recent study by Ha et al (1) illustrates the potential benefit of using exercise stress for detection of early myocardial disease in diabetic patients. With modern advances in cardiac imaging the detection and management sub-clinical disease in patients at high cardiovascular risk is likely to become increasingly relevant. The use of exercise stress and its application outside the conventional app...

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  Dear Editor,

  The recent study by Ha et al (1) illustrates the potential benefit of using exercise stress for detection of early myocardial disease in diabetic patients. With modern advances in cardiac imaging the detection and management sub-clinical disease in patients at high cardiovascular risk is likely to become increasingly relevant. The use of exercise stress and its application outside the conventional application of coronary disease highlights an area of underutilisation in echocardiographic practice.

  The concept of applying a stress modality to assess cardiac status has long been one of the basic principles of our assessment of patients with known or suspected coronary disease and forms a large part of what we do in routine clinical practice. It allows us to better understand the nature of symptoms that develop during physical exertion and can detect asymptomatic disease in at risk individuals. Stress testing also has a lot to offer in other patient groups. As with coronary problems many patients with significant disease have abnormal findings exclusively during stress, resting abnormalities only being manifested in the advanced stages of the process. For example, echocardiography is often performed in the resting state in patients with exertional breathlessness. It frequently reveals normal appearances or only subtle pathology such as early diastolic relaxation abnormalities of uncertain significance. In these circumstances it is plausible that supplementary haemodynamic information could be added by a stress assessment.

  In mobile patients exercise echocardiography is a highly feasible and well-validated technique. It may be preferable to pharmacological stress testing. In the setting of coronary disease incorporation of functional treadmill variables into clinical decision-making adds useful information to echocardiographic data (2). Previous studies have demonstrated the value of exercise echocardiography in populations with valvular (3) and myocardial (4) disease as well as pulmonary hypertension (5). Other applications are developing with implications for diagnosis, therapy and possibly prognosis.

  Stress echocardiography is not just about using a pharmacological agent to look for ischaemia and viability. An exercise protocol can be used in a large proportion of patients and has applicability across a range of clinical problems in cardiology where it supplements information gained at rest.

  REFERENCES

  1. Ha JW, Lee HC, Kang ES et al.
  Abnormal left ventricular longitudinal functional reserve in patients with diabetes mellitus: implication for detecting subclinical myocardial dysfunction using exercise tissue Doppler echocardiography.
  Heart. 2007;93:1571-6.

  2. Marwick T, Case C, Vasey C, Allen S, Short L, Thomas J.
  Prediction of mortality by exercise echocardiography: a strategy for combination with the Duke treadmill score.
  Circulation 2001;103:2566–71.

  3. Lee R, Haluska B, Leung DY, Case C, Mundy J, Marwick TH.
  Functional and prognostic implications of left ventricular contractile reserve in patients with asymptomatic severe mitral regurgitation.
  Heart 2005; 91: 1383-4.

  4. Burgess MI, Jenkins C, Sharman JE, Marwick TH.
  Diastolic stress echocardiography: hemodynamic validation and clinical significance of estimation of ventricular filling pressure with exercise.
  J Am Coll Cardiol. 2006 May 2;47:1891-900.

  5. Collins, N, Bastian B, Quiqueree L, Jones C, Morgan R, Reeves G.
  Abnormal pulmonary vascular responses in patients registered with a systemic autoimmunity database: Pulmonary Hypertension Assessment and Screening Evaluation using stress echocardiography (PHASE-I).
  Eur J Echocardiogr 2006; 7: 439-46.

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  Conflict of Interest:
  None declared.

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