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英文誌(2004-)

Journal of Medical Ultrasonics

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2013 - Vol.40

Vol.40 No.Supplement

特別プログラム 循環器
パネルディスカッション14 <診療に活かす> 負荷心エコー検査:From A to Z

(S236)

Clinical utility of stress echocardiography: From A to Z

PICANO Eugenio

Eugenio PICANO

CNR, Institute of Clinical Physiology, Italy

キーワード :

Stress echocardiography is an established method for the diagnosis and prognostic stratification of coronary artery disease. In the last few years, the tremendous technological and conceptual versatility of the technique has been increasingly applied in challenging diagnostic fields. Ten years ago, only patients with known or suspected coronary artery disease entered the stress echocardiography laboratory, and only regional wall motion by 2D-echo was assessed. Today, in the echocardiography laboratory we can stress not only coronary arteries, but also the coronary microvessels, myocardium, heart valves, pulmonary circulation, alveolar-capillary barrier, and right ventricle. Therefore, we evaluate coronary artery as well as coronary microvascular disease associated with diabetes and hypertension, suspected or overt dilated cardiomyopathy, systolic and diastolic heart failure, hypertrophic cardiomyopathy, athletes, valvular heart disease, children or adults with congenital heart disease, patients with incipient or overt pulmonary hypertension, heart transplanted patients for early detection of chronic or acute rejection and even brain-dead aged potential donors for better selection of suitable donor hearts. From a stress echo era with a one-fits all approach (wall motion by 2D-echo in the patient with known or suspected coronary artery disease) now we moved into an omnivorous, next-generation laboratory with a variety of technologies employed (from M-Mode to 2D and pulsed, continuous and color Doppler, up to lung ultrasound and real time 3D echo, 2D speckle tracking and myocardial contrast echo) on patients covering all the spectrum of severity (from elite athletes to patients with end-stage heart failure) and ages (from children with congenital heart disease to elderly with low flow, flow-gradient aortic stenosis). For each patient, we can tailor a dedicated stress with a specific method to address a particular diagnostic question. Provided that the acoustic window is acceptable and the necessary expertise available, stress echocardiography can be useful and convenient in many situations, from valve to congenital heart disease whenever there is a mismatch between symptoms during stress and findings at rest. The increasing societal concern for cost, environment and long-term radiation risks of medical imaging will lead to a preferential application of ultrasound over competing techniques due to its unsurpassed versatility, portability, absence of radiation and low cost.
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