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To the editor: The recent study by Ha et al1 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 of subclinical 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 underuse 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 our routine clinical practice. It allows us to understand better the nature of symptoms that develop during physical exertion and to detect asymptomatic disease in people at risk. 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. For coronary disease, incorporation of functional treadmill variables into clinical decision-making adds useful information to the echocardiographic data.2 Previous studies have demonstrated the value of exercise echocardiography in groups with valvular3 and myocardial4 disease as well as pulmonary hypertension.5 Other applications are developing with implications for diagnosis, treatment 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.
Competing interests: None.
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