Exercise echocardiography

Table 1 Recommendations for the use of exercise stress echocardiography testing in the initial diagnostic assessment of angina¹

Class I
I	Patients with resting ECG abnormalities, LBBB, > 1 mm ST-depression, paced rhythm, or WPW which prevent accurate interpretation of ECG changes during stress
II	Patients with a non-conclusive exercise ECG but reasonable exercise tolerance, who do not have a high probability of significant coronary disease and in whom the diagnosis is still in doubt
Class IIa
III	Patients with prior revascularization (PCI or CABG) in whom localization of ischemia is important
IV	As an alternative to exercise ECG in patients where facilities, costs, and personnel resources allow
V	As an alternative to exercise ECG in patients with a low pre-test probability of disease such as women with atypical chest pain
VI	To assess functional severity of intermediate lesions on coronary angiography
VII	To localize ischemia when planning revascularization options in patients who have already had arteriography

From: ESC Guidelines on the management of stable angina pectoris: executive summary[3].

¹Pharmacological stress echocardiography is recommended if the patient is unable to exercise adequately.

ECG: Electrocardiography; WPW: Wolf-Parkinson-White syndrome; LBBB: Left bundle branch block; PCI: Percutaneous coronary intervention; CABG: Coronary artery bypass graft. Class I: Benefits are greater than risks, therefore the procedure should be performed; Class IIa: Benefits are greater than risks, although additional studies are required - it is reasonable to perform the procedure.

Table 2 Sensitivity and specificity of stress echocardiography and competing methodologies

	Sensitivity (%)	Specificity (%)
Exercise ECG testing[53]	50	90
Stress echocardiography[54]	80	84
Nuclear techniques[54]	84	77
Magnetic resonance[55]	89	87
Coronary computed tomography[56]	98	90

ECG: Electrocardiography.