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Table of Contents
Intro
Introduction
Contents
Contributors
Part I: The Signs
1: Step A for Regional Wall Motion Abnormality in Stress Echocardiography
1.1 Classic and Alternative Ischemic Cascades
1.2 Left Ventricular Myocardium Segmentation Models
1.3 Assignment of Segments to Coronary Arterial Territories
1.4 Tips and Tricks
1.5 Matching Between Transthoracic and Transesophageal Segments
1.6 Methodology for Assessment of Regional Wall Motion Abnormalities
1.7 Response Patterns
1.8 Diagnostic Results and Accuracy
1.9 False-Negative Results
1.10 False-Positive Results
1.11 Towards Quantitative SE
1.12 Clinical Guidelines and Recommendations
References
2: Step B for B-Lines in Stress Echocardiography
2.1 History and Pathophysiology
2.2 The Main Signs of Pulmonary Congestion: B-Lines
2.3 Methodology: The 4-Site Simplified Scan
2.4 LUS Response Patterns
2.5 Coronary Anatomy and Functional Correlates
2.6 Outcome Data and Implications for Therapy
2.7 Tips and Tricks
2.8 Clinical Guidelines and Recommendations
References
3: Step C for Cardiac Reserve in Stress Echocardiography
3.1 Pathophysiology: From Cardiac Molecules to Ventricular Volumes
3.2 Methodology
3.3 The Main Signs of Normal and Abnormal Contractile Reserve
3.4 Coronary Anatomic, Functional, and Prognostic Correlates
3.5 Tips and Tricks
3.6 Clinical Guidelines and Recommendations
References
4: Step D for Doppler-Based Coronary Flow Velocity Reserve in Stress Echocardiography
4.1 Pathophysiology
4.2 Methodology
4.3 Response Patterns
4.4 Coronary Anatomy and Functional Correlates
4.5 Outcome Data
4.6 Tips and Tricks
4.7 The Value of Resting CFV
4.8 Clinical Guidelines and Recommendations
References.
5: Step E for EKG-Based Heart Rate Reserve in Stress Echocardiography
5.1 Cardiac Autonomic Function
5.2 How to Measure Heart Rate Reserve
5.3 Heart Rate Reserve Response Patterns
5.4 Anatomic and Functional Correlates
5.5 Outcome Data
5.6 Tips and Tricks
5.7 Clinical Guidelines
References
6: Step F for Mitral Regurgitant Flow in Stress Echocardiography
6.1 Mitral Regurgitation as a Disease and as a Syndrome
6.2 How to Measure MR
6.3 Response Patterns During Stress
6.4 Anatomic and Functional Correlates
6.5 Outcome Data
6.6 Tips and Tricks
6.7 Clinical Guidelines and Recommendations
References
7: Step G for Gradients in Stress Echocardiography
7.1 Preload, Contractility, and Dynamic Gradients
7.2 Methodology
7.3 The Main Signs of Obstruction and Response Patterns
7.4 Tips and Tricks
7.5 Clinical Guidelines and Recommendations
References
8: Step L for Left Atrium Stress Echocardiography
8.1 The Physiology of the Left Atrium
8.2 How to Measure LAV and Function
8.3 Response Patterns in SE
8.4 Coronary Anatomic and Functional Correlates
8.5 Outcome Data
8.6 Tips and Tricks
8.7 Clinical Guidelines and Recommendations
References
9: Step P for Pulmonary Hemodynamics in Stress Echocardiography
9.1 Physiology of Pulmonary Circulation
9.2 How to Measure Pulmonary Artery Pressure
9.3 Response Patterns of Pulmonary Hemodynamics During Exercise
9.4 Functional Correlates of PH
9.5 Outcome Data
9.6 Tips and Tricks
9.7 Clinical Guidelines and Recommendations
References
10: Step R for Right Ventricular Function in Stress Echocardiography
10.1 Right Ventricle Anatomy and Function
10.2 How to Measure Global RV Function
10.3 Right Ventricular Response Patterns During Stress.
10.4 Coronary Anatomic and Functional Correlates of Regional RV Function
10.5 Outcome Data
10.6 Tips and Tricks
10.7 Clinical Guidelines and Recommendations
References
11: ABCDE Protocol for Stress Echocardiography in Chronic Coronary Syndromes
11.1 From Coronary Stenosis to Patient Vulnerability
11.2 How to Do ABCDE-SE
11.3 Response Patterns of ABCDE-SE
11.4 Coronary Anatomic and Functional Correlates
11.5 Outcome Data
11.6 Tips and Tricks
11.7 Recommendations: A Paradigm Shift
References
12: The ABCDE-FGLPR Protocol for Stress Echocardiography Beyond Coronary Artery Disease
12.1 Beyond Coronary Artery Disease
12.2 How to Do the New Steps: FGLPR
12.3 Tips and Tricks
12.4 Recommendations and Guidelines
References
Part II: Training and Technology
13: Strain and Real-Time Three-Dimensional Stress Echocardiography
13.1 Toward Quantitative Stress Echocardiography
13.2 Anatomic Basis of Myocardial Contraction
13.3 Spatial and Temporal Heterogeneity of Left Ventricular Contraction
13.4 Speckle Tracking Technique
13.5 The Possible Role of Stress Speckle Tracking Echocardiography
13.6 Three-Dimensional Echocardiography
13.7 Pitfalls
13.8 Clinical Guidelines
References
14: Contrast Stress Echocardiography
14.1 Historical Background and Pathophysiological Basis
14.2 Contrast Agents
14.3 Contrast Administration
14.4 Contrast Imaging Modalities
14.5 Clinical Applications 1: Enhancement of Left Ventricular Endocardial Borders
14.6 Clinical Applications 2: Quantitative Volumetric SE
14.7 Clinical Applications 3: Enhancement of Color Doppler Imaging of the Mid-Distal Left Anterior Descending Artery
14.8 Clinical Applications 4: MCE for Myocardial Perfusion Imaging
14.9 Pitfalls
14.10 Safety and Cost.
14.11 Clinical Indications and Recommendations
References
15: Artificial Intelligence and Robotic Stress Echocardiography
15.1 The Need for Artificial Intelligence in Stress Echocardiography
15.2 From Eyeballing to Quantification
15.3 Exposing Information Missed by the Eye
15.4 Hybrid Imaging
15.5 Data Handling: Network Analysis
15.6 Robotic Stress Echocardiography
15.7 Recommendations and Vision
References
16: Technology and Training Requirements in Stress Echocardiography
16.1 Introduction
16.2 General Test Protocol
16.3 Imaging Equipment and Techniques
16.4 Training Requirements
16.5 Pitfalls
16.6 Clinical Guidelines
References
Part III: The Stresses: How, When, and Why
17: Exercise Echocardiography
17.1 Historical Background
17.2 Pathophysiology
17.3 Exercise Techniques
17.4 Safety and Feasibility
17.5 Diagnostic Results for Detection of Coronary Artery Disease and Myocardial Viability
17.6 Prognostic Value
17.7 Exercise Echocardiography Outside Coronary Artery Disease
17.8 Pitfalls
17.9 Clinical Guidelines
References
18: Dobutamine Stress Echocardiography
18.1 Historical Background
18.2 Pharmacology and Pathophysiology
18.3 Methodology, Protocol, and Performance of DSE
18.4 Myocardial Response and Testing Interpretation
18.5 Feasibility and Safety
18.6 Diagnostic Results for Detection of Coronary Artery Disease
18.7 Dobutamine as a Test of Coronary Vasospasm by Serendipity
18.8 Identification of Myocardial Viability
18.9 Prognostic Value
18.10 Pitfalls and Specific Considerations
18.11 Contraindications
18.12 Guidelines and Recommendations
References
19: Dipyridamole Stress Echocardiography
19.1 Background
19.2 Pharmacology
19.3 Pathophysiology.
19.4 Methodology and Response Patterns
19.5 Feasibility and Safety
19.6 Diagnostic Results for Detection of Coronary Artery Disease
19.7 Myocardial Viability
19.8 Ischemia with Nonobstructive Coronary Arteries
19.9 Prognostic Value
19.10 The Added Value of ABCDE Protocol
19.11 Indications and Contraindications
19.12 Pitfalls
19.13 Clinical Guidelines
References
20: Adenosine, Regadenoson Stress Echocardiography
20.1 Background
20.2 Pharmacology and Pathophysiology
20.2.1 Adenosine Receptors
20.2.2 The Pharmacological Goal for Vasodilator for SE
20.2.3 Pharmacologic Comparison of Vasodilator Agents (Adenosine, Dipyridamole, and Regadenoson)
20.2.4 Hemodynamic Effect Adenosine
20.3 Methodology
20.4 Tolerability and Safety
20.5 Indications, Contraindications, and Influencing Factors
20.6 The Main Stress Markers of Coronary Artery Disease and Their Diagnostic Accuracy
20.7 Prognostic Value of Adenosine SE
20.8 Practical Aspects: Cost and Availability
20.9 Clinical Guidelines
References
21: Pacing Stress Echocardiography
21.1 Historical Background
21.2 Pathophysiology
21.3 Methodology
21.4 Clinical Results and Comparison with Other SE Tests
21.5 Pitfalls
21.6 Clinical Indications
References
22: Ergonovine Stress Echocardiography for the Diagnosis of Vasospastic Angina
22.1 Coronary Vasospasm of Large and Small Vessels
22.2 Basic Considerations
22.3 Protocol
22.4 Noninvasive Diagnosis of Coronary Artery Spasm: Clinical Data
22.5 Special Safety Considerations
22.6 Clinical and Prognostic Impact
22.7 Pitfalls
22.8 Clinical Guidelines
References
23: Hyperventilation, Handgrip, Cold Pressor Stress Echocardiography
23.1 Hyperventilation Test
23.2 Handgrip SE
23.3 Cold Pressor SE.
Introduction
Contents
Contributors
Part I: The Signs
1: Step A for Regional Wall Motion Abnormality in Stress Echocardiography
1.1 Classic and Alternative Ischemic Cascades
1.2 Left Ventricular Myocardium Segmentation Models
1.3 Assignment of Segments to Coronary Arterial Territories
1.4 Tips and Tricks
1.5 Matching Between Transthoracic and Transesophageal Segments
1.6 Methodology for Assessment of Regional Wall Motion Abnormalities
1.7 Response Patterns
1.8 Diagnostic Results and Accuracy
1.9 False-Negative Results
1.10 False-Positive Results
1.11 Towards Quantitative SE
1.12 Clinical Guidelines and Recommendations
References
2: Step B for B-Lines in Stress Echocardiography
2.1 History and Pathophysiology
2.2 The Main Signs of Pulmonary Congestion: B-Lines
2.3 Methodology: The 4-Site Simplified Scan
2.4 LUS Response Patterns
2.5 Coronary Anatomy and Functional Correlates
2.6 Outcome Data and Implications for Therapy
2.7 Tips and Tricks
2.8 Clinical Guidelines and Recommendations
References
3: Step C for Cardiac Reserve in Stress Echocardiography
3.1 Pathophysiology: From Cardiac Molecules to Ventricular Volumes
3.2 Methodology
3.3 The Main Signs of Normal and Abnormal Contractile Reserve
3.4 Coronary Anatomic, Functional, and Prognostic Correlates
3.5 Tips and Tricks
3.6 Clinical Guidelines and Recommendations
References
4: Step D for Doppler-Based Coronary Flow Velocity Reserve in Stress Echocardiography
4.1 Pathophysiology
4.2 Methodology
4.3 Response Patterns
4.4 Coronary Anatomy and Functional Correlates
4.5 Outcome Data
4.6 Tips and Tricks
4.7 The Value of Resting CFV
4.8 Clinical Guidelines and Recommendations
References.
5: Step E for EKG-Based Heart Rate Reserve in Stress Echocardiography
5.1 Cardiac Autonomic Function
5.2 How to Measure Heart Rate Reserve
5.3 Heart Rate Reserve Response Patterns
5.4 Anatomic and Functional Correlates
5.5 Outcome Data
5.6 Tips and Tricks
5.7 Clinical Guidelines
References
6: Step F for Mitral Regurgitant Flow in Stress Echocardiography
6.1 Mitral Regurgitation as a Disease and as a Syndrome
6.2 How to Measure MR
6.3 Response Patterns During Stress
6.4 Anatomic and Functional Correlates
6.5 Outcome Data
6.6 Tips and Tricks
6.7 Clinical Guidelines and Recommendations
References
7: Step G for Gradients in Stress Echocardiography
7.1 Preload, Contractility, and Dynamic Gradients
7.2 Methodology
7.3 The Main Signs of Obstruction and Response Patterns
7.4 Tips and Tricks
7.5 Clinical Guidelines and Recommendations
References
8: Step L for Left Atrium Stress Echocardiography
8.1 The Physiology of the Left Atrium
8.2 How to Measure LAV and Function
8.3 Response Patterns in SE
8.4 Coronary Anatomic and Functional Correlates
8.5 Outcome Data
8.6 Tips and Tricks
8.7 Clinical Guidelines and Recommendations
References
9: Step P for Pulmonary Hemodynamics in Stress Echocardiography
9.1 Physiology of Pulmonary Circulation
9.2 How to Measure Pulmonary Artery Pressure
9.3 Response Patterns of Pulmonary Hemodynamics During Exercise
9.4 Functional Correlates of PH
9.5 Outcome Data
9.6 Tips and Tricks
9.7 Clinical Guidelines and Recommendations
References
10: Step R for Right Ventricular Function in Stress Echocardiography
10.1 Right Ventricle Anatomy and Function
10.2 How to Measure Global RV Function
10.3 Right Ventricular Response Patterns During Stress.
10.4 Coronary Anatomic and Functional Correlates of Regional RV Function
10.5 Outcome Data
10.6 Tips and Tricks
10.7 Clinical Guidelines and Recommendations
References
11: ABCDE Protocol for Stress Echocardiography in Chronic Coronary Syndromes
11.1 From Coronary Stenosis to Patient Vulnerability
11.2 How to Do ABCDE-SE
11.3 Response Patterns of ABCDE-SE
11.4 Coronary Anatomic and Functional Correlates
11.5 Outcome Data
11.6 Tips and Tricks
11.7 Recommendations: A Paradigm Shift
References
12: The ABCDE-FGLPR Protocol for Stress Echocardiography Beyond Coronary Artery Disease
12.1 Beyond Coronary Artery Disease
12.2 How to Do the New Steps: FGLPR
12.3 Tips and Tricks
12.4 Recommendations and Guidelines
References
Part II: Training and Technology
13: Strain and Real-Time Three-Dimensional Stress Echocardiography
13.1 Toward Quantitative Stress Echocardiography
13.2 Anatomic Basis of Myocardial Contraction
13.3 Spatial and Temporal Heterogeneity of Left Ventricular Contraction
13.4 Speckle Tracking Technique
13.5 The Possible Role of Stress Speckle Tracking Echocardiography
13.6 Three-Dimensional Echocardiography
13.7 Pitfalls
13.8 Clinical Guidelines
References
14: Contrast Stress Echocardiography
14.1 Historical Background and Pathophysiological Basis
14.2 Contrast Agents
14.3 Contrast Administration
14.4 Contrast Imaging Modalities
14.5 Clinical Applications 1: Enhancement of Left Ventricular Endocardial Borders
14.6 Clinical Applications 2: Quantitative Volumetric SE
14.7 Clinical Applications 3: Enhancement of Color Doppler Imaging of the Mid-Distal Left Anterior Descending Artery
14.8 Clinical Applications 4: MCE for Myocardial Perfusion Imaging
14.9 Pitfalls
14.10 Safety and Cost.
14.11 Clinical Indications and Recommendations
References
15: Artificial Intelligence and Robotic Stress Echocardiography
15.1 The Need for Artificial Intelligence in Stress Echocardiography
15.2 From Eyeballing to Quantification
15.3 Exposing Information Missed by the Eye
15.4 Hybrid Imaging
15.5 Data Handling: Network Analysis
15.6 Robotic Stress Echocardiography
15.7 Recommendations and Vision
References
16: Technology and Training Requirements in Stress Echocardiography
16.1 Introduction
16.2 General Test Protocol
16.3 Imaging Equipment and Techniques
16.4 Training Requirements
16.5 Pitfalls
16.6 Clinical Guidelines
References
Part III: The Stresses: How, When, and Why
17: Exercise Echocardiography
17.1 Historical Background
17.2 Pathophysiology
17.3 Exercise Techniques
17.4 Safety and Feasibility
17.5 Diagnostic Results for Detection of Coronary Artery Disease and Myocardial Viability
17.6 Prognostic Value
17.7 Exercise Echocardiography Outside Coronary Artery Disease
17.8 Pitfalls
17.9 Clinical Guidelines
References
18: Dobutamine Stress Echocardiography
18.1 Historical Background
18.2 Pharmacology and Pathophysiology
18.3 Methodology, Protocol, and Performance of DSE
18.4 Myocardial Response and Testing Interpretation
18.5 Feasibility and Safety
18.6 Diagnostic Results for Detection of Coronary Artery Disease
18.7 Dobutamine as a Test of Coronary Vasospasm by Serendipity
18.8 Identification of Myocardial Viability
18.9 Prognostic Value
18.10 Pitfalls and Specific Considerations
18.11 Contraindications
18.12 Guidelines and Recommendations
References
19: Dipyridamole Stress Echocardiography
19.1 Background
19.2 Pharmacology
19.3 Pathophysiology.
19.4 Methodology and Response Patterns
19.5 Feasibility and Safety
19.6 Diagnostic Results for Detection of Coronary Artery Disease
19.7 Myocardial Viability
19.8 Ischemia with Nonobstructive Coronary Arteries
19.9 Prognostic Value
19.10 The Added Value of ABCDE Protocol
19.11 Indications and Contraindications
19.12 Pitfalls
19.13 Clinical Guidelines
References
20: Adenosine, Regadenoson Stress Echocardiography
20.1 Background
20.2 Pharmacology and Pathophysiology
20.2.1 Adenosine Receptors
20.2.2 The Pharmacological Goal for Vasodilator for SE
20.2.3 Pharmacologic Comparison of Vasodilator Agents (Adenosine, Dipyridamole, and Regadenoson)
20.2.4 Hemodynamic Effect Adenosine
20.3 Methodology
20.4 Tolerability and Safety
20.5 Indications, Contraindications, and Influencing Factors
20.6 The Main Stress Markers of Coronary Artery Disease and Their Diagnostic Accuracy
20.7 Prognostic Value of Adenosine SE
20.8 Practical Aspects: Cost and Availability
20.9 Clinical Guidelines
References
21: Pacing Stress Echocardiography
21.1 Historical Background
21.2 Pathophysiology
21.3 Methodology
21.4 Clinical Results and Comparison with Other SE Tests
21.5 Pitfalls
21.6 Clinical Indications
References
22: Ergonovine Stress Echocardiography for the Diagnosis of Vasospastic Angina
22.1 Coronary Vasospasm of Large and Small Vessels
22.2 Basic Considerations
22.3 Protocol
22.4 Noninvasive Diagnosis of Coronary Artery Spasm: Clinical Data
22.5 Special Safety Considerations
22.6 Clinical and Prognostic Impact
22.7 Pitfalls
22.8 Clinical Guidelines
References
23: Hyperventilation, Handgrip, Cold Pressor Stress Echocardiography
23.1 Hyperventilation Test
23.2 Handgrip SE
23.3 Cold Pressor SE.