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      Stress echocardiography in coronary artery disease: a practical guideline from the British Society of Echocardiography

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          Abstract

          Stress echocardiography is an established technique for assessing coronary artery disease. It has primarily been used for the diagnosis and assessment of patients presenting with chest pain in whom there is an intermediate probability of coronary artery disease. In addition, it is used for risk stratification and to guide revascularisation in patients with known ischaemic heart disease. Although cardiac computed tomography has recently been recommended in the United Kingdom as the first-line investigation in patients presenting for the first time with atypical or typical angina, stress echocardiography continues to have an important role in the assessment of patients with lesions of uncertain functional significance and patients with known ischaemic heart disease who represent with chest pain. In this guideline from the British Society of Echocardiography, the indications and recommended protocols are outlined for the assessment of ischaemic heart disease by stress echocardiography.

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          Myocardial strain imaging: how useful is it in clinical decision making?

          Myocardial strain is a principle for quantification of left ventricular (LV) function which is now feasible with speckle-tracking echocardiography. The best evaluated strain parameter is global longitudinal strain (GLS) which is more sensitive than left ventricular ejection fraction (LVEF) as a measure of systolic function, and may be used to identify sub-clinical LV dysfunction in cardiomyopathies. Furthermore, GLS is recommended as routine measurement in patients undergoing chemotherapy to detect reduction in LV function prior to fall in LVEF. Intersegmental variability in timing of peak myocardial strain has been proposed as predictor of risk of ventricular arrhythmias. Strain imaging may be applied to guide placement of the LV pacing lead in patients receiving cardiac resynchronization therapy. Strain may also be used to diagnose myocardial ischaemia, but the technology is not sufficiently standardized to be recommended as a general tool for this purpose. Peak systolic left atrial strain is a promising supplementary index of LV filling pressure. The strain imaging methodology is still undergoing development, and further clinical trials are needed to determine if clinical decisions based on strain imaging result in better outcome. With this important limitation in mind, strain may be applied clinically as a supplementary diagnostic method.
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            The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability

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              Physiologic basis for assessing critical coronary stenosis. Instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve.

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                Author and article information

                Journal
                Echo Res Pract
                Echo Res Pract
                echo
                Echo Research and Practice
                Bioscientifica Ltd (Bristol )
                2055-0464
                June 2019
                28 March 2019
                : 6
                : 2
                : G17-G33
                Affiliations
                [1 ]Department of Cardiology , Institute of Cardiovascular Science, University Hospital Birmingham, Birmingham, UK
                [2 ]Department of Cardiology , University Hospital of Wales, Cardiff, UK
                [3 ]Department of Cardiology , St Bartholomew’s Hospital, London, UK
                [4 ]Department of Cardiology , Kings College Hospital, London, UK
                [5 ]Department of Cardiology , National Heart Lung Institute, Hammersmith Hospital, London, UK
                [6 ]Department of Cardiology , Royal Brompton Hospital, London, UK
                [7 ]Department of Cardiology , Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
                Author notes
                Correspondence should be addressed to R P Steeds: rick.steeds@ 123456uhb.nhs.uk

                *R P Steeds, R Wheeler, P Nihoyannopoulos, R Senior, M J Monaghan and V Sharma are members of the editorial board of Echo Research and Practice. They were not involved in the review or editorial process for this paper, on which they are listed as authors

                (V Sharma is the Guidelines Chair)

                Article
                ERP-18-0068
                10.1530/ERP-18-0068
                6477657
                30921767
                21f53c2c-cad6-456f-a7b2-fec18d41767d
                © 2019 The British Society of Echocardiography

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 18 December 2019
                : 28 March 2019
                Categories
                Guidelines and Recommendations

                stress echocardiography,coronary artery disease,exercise,pharmacological stress,myocardial perfusion,3d echocardiography,left ventricular opacification contrast

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                Most referenced authors1,012