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Multiple studies published in the last 2 decades have demonstrated the usefulness of stress echocardiography in the diagnosis and prognosis of ischemic heart disease. In its pharmacological modalities, dobutamine stress echocardiography is used for the diagnosis of ischemic heart disease 1 to identify patients with a poor prognosis after acute myocardial infarction 2 and medically stabilized unstable angina. 3 It is also widely recognized in the detection of myocardial viability 4 due to its wellbalanced sensitivity and specificity. The multicenter studies done by Picano’s group popularized another pharmacological modality using dipyridamole. 5 Although drugs are a priori easier and simpler to apply, they are not free from contraindications and risks, and these are more frequent in the case of dobutamine. 6 Furthermore, oxygen consumption induced by physical exercise and, thus, its ability to cause ischemia, is increased by the use of dobutamine. On the other hand, dipyridamole has shown low sensitivity (similar to the standard exercise stress test) in the detection of 1- or 2-vessel disease. 7 Thus, it seems natural that the indication for pharmacological stress echocardiography is increasingly restricted to those patients who cannot make physical efforts or to study myocardial viability. Exercise echocardiography (EE) does not involve the shortcomings of using the electrocardiogram in the standard exercise stress test and is an effective alternative to radioisotopic techniques that use perfusion as a marker of ischemia. Not only are there technical advantages, such as its wide availability, but also clinical ones, since 2 investigations are done simultaneously: the baseline examination that identifies possible unknown diseases and assesses baseline ventricular function, and the analysis of |
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