Assessment of coronary artery disease by exercise echocardiography

Exercise echocardiography consists of the addition of echocardiographic imaging and conventional exercise testing. Exercise echo has an interesting profile for non-invasive evaluation of coronary artery disease due to its safety, cost-effectiveness, diagnostic and prognostic capabilities, and absence of radiation. Besides its recognized value when resting ECG is non-diagnostic, or when non conclusive results are achieved during ECG exercise testing, recent guidelines establish exercise echo as a feasible diagnostic and/or prognostic alternative to conventional exercise testing in centers where facilities are available. Sensitivity of exercise echo can be further increased if training in peak instead of post-exercise imaging is achieved. Former limitations as those derived from bad acoustic window, have been significantly solved with harmonic imaging and contrast agents for border detection, The new technology is promising for exercise echo. 3-dimensional echocardiography may have a role as a full volume of the entire myocardium can be acquired in only a few cardiac cycles. Finally, 2-dimensional strain (speckle) can easily assess myocardial torsion, which has been found to be diminished under ischemic conditions.