Plcano . Stress Echocardlography . Fourth Edition

Springer-Verlag Berlin Heidelberg GmbH

Eugenio Picano

Stress Echocardiography Fourth Edition

With 212 Figures and 76 Tables

, Springer

Eugenio Picano, MD, PhD, FESC

Senior Medical Researcher of Italian National Research Council Director, Echocardiography and Stress Testing Lab Institute of Clinical Physiology, Pis a Scientific Director Cardiology, Clinica Cardiologica Montevergine, Mercogliano, Avellino Editor-in-Chief Biomed Central Net journal Cardiovascular Ultrasound (www.cardiovascularultrasound.com)

Institute of Clinical Physiology National Research Council Via Moruzzi, 1 56124 Pisa, Italy

e-mail: picano@ifc.cnr.it www.beatoporco.it www.ifc.pi.cnr.itlecolandlindex. html

ISBN 978-3-662-05098-9 ISBN 978-3-662-05096-5 (eBook) DOI 10.1007/978-3-662-05096-5

Library of Congress Cataloging-in-Publication Data Picano, Eugenio, 1958- . Stress echocardiography/Eugenio Picano. - 4th ed. p.; cm. Includes bibliographical references and index. 1. Stress echocardiography. I. Title. [DNLM: 1. Echocardiography, Stress. 2. Coronary Disease - diagnosis. WG 141.5.E2 P585s 2003) RC683.5.SnP532003 616.1'2307543- dC21

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© Springer-Verlag Berlin Heidelberg 2003 Originally published by Springer-Verlag Berlin Heidelberg New York in 2003. Softcover reprint of the hardcover 4th edition 2003

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TO EUGENIA, BENEDETTA, A~D ... NANDA

Preface

This book has a past. Its different editions parallel the growth of stress echocardiogra­phy in the scientific community and in the clinical arena. In 1991, the first edition con­sisted of 100 pages, which increased to 200 in the second (1994),300 in the third (1997) up to nearly 500 pages in the present fourth edition. The general perception of stress echo cardiography has changed in the cardiological community. It is no longer a prom­ising innovation viewed with mixed feelings of suspicion and attraction, but an estab­lished technique with an enormous potential for solving the present paradox of saving good health care money and, at the same time, improving diagnostic standards. In a cardiological climate where useless and redundant imaging examinations proliferate, stress echocardiography has the unique advantage of being used by cardiologists, and this - at least theoretically - makes command of technology easier. Today, stress echocardiographers are not imaging specialists living a cardiological experience, but rather cardiologists living an imaging experience - with an ultrasound technique free of biohazards for the patient and with no ecological stress for the planet. By choice and by necessity, the modern, responsible diagnosis of cardiac imaging needs to be eco­nomic, eco-logic, and therefore usually echo-cardiographic.

The book was totally single authored in the first edition, then had distinguished contributors in the subsequent editions, up to the record number of 30 contributors in the present edition. They come from 11 different countries spanning four continents and represent, in my opinion, some of the best available knowledge and expertise in their own field of interest. I am pleased and honored that they accepted the invitation to be a part of this project. At the same time, I aimed to avoid the fragmentations, gaps, and inconsistencies of a multi-author text, therefore asking - with no mercy - for revi­sions, cuts, additions and integrations of virtually every contributor. To all of them, and to the junior and senior colleagues who have worked with me over the last 20 years­far too many to be mentioned here - grazie.

Pisa, April 2003 Eugenio Picano

Contents

Stress Echocardiography: A Historical Perspective (or How I Ate My Father) Eugenio Picano

2 Anatomical and Functional Targets of Stress Testing. . . . . . . . . . . . . . .. 17 Eugenio Picano

3 Symptoms and Signs of Myocardial Ischemia ................... 27 Eugenio Picano

4 Rational Basis of Stress Echocardiography . . . . . . . . . . . . . . . . . . . .. 37

Eugenio Picano

5 Echocardiographic Signs of Ischemia . . . . . . . . . . . . . . . . . . . . . . .. 45 Eugenio Picano

6 Segmentation ofthe Left Ventricle. . . . . . . . . . . . . . . . . . . . . . . .. 57 Eugenio Picano

7 Right Ventricular Ischemia in Stress Echocardiography . . . . . . . . . . . . .. 67 Jose Alberto San Roman· Isidre Vilacosta

8 Pathogenetic Mechanisms of Stress Eugenio Picano

. . . . . . . . . . . . . . . . . .. 75

9 Stress Echocardiography: Instructions for Use . . . . . . . . . . . . . . . . . .. 91 Eugenio Picano

10 Exercise Echocardiography ............................. 103 Eugenio Picano

11 Dobutamine Stress Echocardiography . . . . . . . . . . . . . . . . . . . . . . . 115 Eugenio Picano

12 Dipyridamole Stress Echocardiography ...................... 133 Eugenio Picano

X Contents

13 Adenosine Stress Echocardiography ........................ 155 Miodrag Ostojic· Ana Djordjevic-Dikic· Eugenio Picano

14 Pacing Stress Echocardiography Eugenio Picano

15 Ergonovine Stress Echocardiography

........... 165

for the Diagnosis of Vasospastic Angina . . . . . . . . . . . . . . . . . . . . . . 173 Jae-Kwan Song

16 Hyperventilation Test . ............................... 183 Eugenio Picano

17 Grading of Ischemic Response ......... . . . . . . . . . . . . . . . . . . 189 Eugenio Picano

18 Diagnostic Results and Indications . ........................ 199 Eugenio Picano

19 Echocardiographic Recognition of Myocardial Viability .............. 213 Eugenio Picano

20 Diagnostic Flowcharts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 Eugenio Picano

21 Prognosis ...................................... 239 Eugenio Picano

22 Tissue Harmonic Imaging, Anatomical M-Mode, and Three-Dimensional Imaging in Stress Echocardiography ........... 253 Donato Mele

23 New Technologies in Stress Echocardiography: Tissue Doppler and Strain Rate Imaging . . . . . . . . . . . . . . . . . . 263 Genevieve Derumeaux

24 New Technologies in Stress Testing: Acoustic Quantification and Color Kinesis ..................... 275 Jeanne M. DeCara . Roberto M. Lang

25 Tissue Characterization . . ..................... 291 Eugenio Picano

26 Transesophageal Echocardiography for Evaluation of Coronary Artery Disease . . . . . . . . . . . . . . . . . . . . . 299 Attila Palinkas . Eugenio Picano

Contents XI

27 Myocardial Contrast Stress Echocardiography . . . . . . . . . . . . . . . . . . . 311 Thomas R. Porter· Lucia Venneri . Feng Xie

28 Special Subsets of Angiographically Defined Patients: Normal Coronary Arteries, Single-Vessel Disease, Left Main Coronary Artery Disease, Major Noncardiac Vascular Surgery, Patients Undergoing Coronary Revascularization ................. 329 Eugenio Picano . Rosa Sicari

29 Special Subsets of Electrocardiographically Defined Patients: Left Bundle Branch Block, Right Bundle Branch Block, Atrial Fibrillation . . . . . 339 Eugenio Picano . Lauro Cortigiani

30 Special Subsets of Clinically Defined Patients: Elderly, Women, Outpatients, Diabetics, Chest Pain Unit Patients . ........ 345 Eugenio Picano . Emilio Pasanisi

31 Microvascular Disease: Syndrome X, Hypertrophic Cardiomyopathy, and Arterial Hypertension ... . . . . . . . . . . . . . . . . . . . . . . . . . . 355 Eugenio Picano

32 Stress Echocardiography in Dilated Cardiomyopathy . . . . . . . . . . . . 369 Eugenio Picano . Alexander Neskovic . Lorenza Pratali

33 Stress Echocardiography After Cardiac Transplantation. . ........... 377 Christoph H. Spes· Christiane E. Angermann

34 Stress Doppler Echocardiography in Valvular Heart Disease . ........... 387 Jean-Louis J. Vanoverschelde· Agnes Pasquet

3S Stress Echocardiography Versus Cardiac Magnetic Resonance Imaging . . . . . . 403 Heiko Mahrholdt . Anja Wagner· Robert M. Judd· Udo Sechtem

36 Stress Echocardiography and Nuclear Imaging. . ...... 419 Tom Marwick

37 Coronary Flow Reserve ............................... 437 Eugenio Picano . Fausto Rigo . Jorge Lowenstein

38 Endothelial Function in the Stress Echocardiography Laboratory. . . . . . . . . 455 Eugenio Picano

39 Ulysses' Syndrome . ................................. 469 Eugenio Picano . Gaetano Mottola

Subject Index . ...................................... 477

List of Contributors

Chapter 7

Jose Alberto San Roman, MD, PhD, FESC Department of Cardiology, Hospital Universitario, Valla do lid, Spain

Isidre Vilacosta, MD, PhD, FESC Department of Cardiology, Hospital Universitario San Carlos, Madrid, Spain

Chapter 13

Miodrag Ostojic, MD, PhD, FESC Institute for Cardiovascular Disease, Cardiovascular Laboratory and Interventional Cardiology, University Medical Center, Belgrade, Serbia-Montenegro

Ana Djordjevic-Dikic, MD, PhD Institute for Cardiovascular Disease, Cardiovascular Laboratory and Interventional Cardiology, University Medical Center, Belgrade, Serbia-Montenegro

Chapter 1S

Jae-Kwan Song, MD, PhD Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea

Chapter 22

Donato Mele, MD Division of Cardiology, Arcispedale SAnna, Cento, Ferrara, Italy

Chapter 23

Genevieve Derumeaux, MD Division of Cardiology, Rouen University, Rouen, France

Chapter 24

Jeanne M. DeCara, MD Noninvasive Cardiac Imaging Laboratories, Division of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA

Roberto M. Lang, MD Noninvasive Cardiac Imaging Laboratories, Division of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA

XIV List of Contributors

Chapter 26

Attila Palinkas, MD Division of Cardiology, University of Szeged, Szeged, Hungary

Chapter 27

Thomas R. Porter, MD University of Nebraska Medical Center, Omaha, Nebraska, USA

Lucia Venneri, MD, PhD CNR, Institute of Clinical Physiology, Pis a, Italy

FengXie,MD University of Nebraska Medical Center, Omaha, Nebraska, USA

Chapter 28

Rosa Sicari, MD CNR, Institute of Clinical Physiology, Pisa, Italy

Chapter 29

Lauro Cortigiani, MD Cardiovascular Unit, "Campo di Marte" Hospital, Lucca, Italy

Chapter 30

Emilio Pasanisi, MD CNR, Institute of Clinical Physiology, Pisa, Italy

Chapter 32

Alexander Neskovic, MD Cardiovascular Research Center, Dedinje Cardiovascular Institute, Belgrade, Serbia-Montenegro

Lorenza Pratali, MD CNR, Institute of Clinical Physiology, Pis a, Italy

Chapter 33

Christoph H. Spes, MD Division of Cardiology, Munich, Germany

Christiane E. Angermann, MD Division of Cardiology, Wurzburg, Germany

List of Contributors XV

Chapter 34

Jean-Louis Vanoverschelde, MD, PhD Division of Cardiology, Cliniques Universitaires St Luc, Brussels, Belgium

Agnes Pasquet, MD Division of Cardiology, Universite Catholique de Louvain, Brussels, Belgium

Chapter 3S

Heiko Mahrholdt, MD Robert-Bosch-Medical Center, Stuttgart, Germany

Anja Wagner, MD Robert-Bosch-Medical Center, Stuttgart, Germany

Robert M. Judd, PhD Duke Cardiovascular Magnetic Resonance Center, Duke University, Durham, USA

Udo Sechtem, MD, FESC, FACC Robert-Bosch-Medical Center, Stuttgart, Germany

Chapter 36

Tom Marwick, MD, PhD University of Queensland, Brisbane, Australia

Chapter 37

Fausto Rigo, MD Cardiology Division, Umberto I Hospital, Mestre, Italy

Jorge Lowenstein, MD Sanatorio Mitre de Buenos Aires, Buenos Aires, Argentina

Chapter 39

Gaetano Mottola, MD Clinica Cardiologica Monte Vergine, Mercogliano, Avellino, Italy