Utility of Stress cardiography to identify myocardial ischemia

The dobutamine echocardiography takes more and more an important place in diagnosis, prognosis and therapeutics strategies of the coronary disease. We prospectively enrolled 130 consecutive patients followed for a coronary insufficiency. The aim of determinating the diagnostic value of the dobutamine echocardiography in the myocardial ischemia compared with the classic means as the exercise test and the myocardial scintigraphy. Our results are comparable to the data of the literature, the dobutamine echocardiography is more specific than the exercise test and the myocardial scintigraphy [96%, 61% and 53%], more sensitive than exercise test [75% versus 47%] but less sensitive than the myocardial scintigraphy [75% versus 96%]. The stress echocardiography has the best diagnosis precision 87%, against 72% for the scintigraphy and 56% for the exercise test. The dobutamine echocardiography is a very feasible, tolerated well exam and especially very reliable in term of detection of the coronary disease in the feminine population, with a sensibility at 66,7%, a specificity at 100% and a diagnostic precision at 92%, also in patient with hypertension the stress echocardiography is much more specific and reliable than the exercise test [100% vs 22% and 93% vs 54%, respectively], and it's superior to the exercise test in the presence of electric signs of systolic excess load and to the myocardial scintigraphy in case of left ventricular hypertrophy. The dobutamine echocardiography can be considered as safety and reliable means of investigation of the coronary insufficiency

[Stress echocardiography and mitral stenosis: what interest?]

The stress echocardiography is used extensively as a diagnostic and prognostic tool and the assessment of ischemic cardiopathies. Its use in valvulopathies is more limited, but is increasing with time. The discrepancies between the functional symptoms and hemodynamics at rest is frequently met in patients with mitral stenosis. By assessing changes of pressures, gradients and surface stress echocardiography helps to identify the real hemodynamic conditions permitting to recommend a more aggressive approach in certain situations

[Introduction of the myocardal dopler tissue imaging]

Introduced in 1989, the myocardial doppler tissue imaging has now many clinical applications. The doppler tissue imaging explores the proper systolic and diastolic regional function of myocardial fibers. We can measure myocardial velocities by recording signals of low v‚locitiy and high magnitude, the strain and the strain rate are then derived from velocities. Specific softwares are therefore necessary. There are many ways of recording and representing myocardial doppler tissue parameters. Diagnostic and prognostic value of myocardial doppler tissue imaging is now proved and this method has many applications in ischemic cardiopathy and in cardiomyopathies. The development of powerful softwares is promising for the applications of the strain in the future