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Peak Systolic Frames

Fig. 10. A 47-yr-old male status postheart transplant. Myocardial contrast agent (Definity®, perflutren lipid micropsheres) was used to improve endocardial definition both at baseline and during image acquisition. Dobutamine was infused up to a peak dose of 20 ^g/kg/min. The target heart rate of 160 bpm was achieved. Peak blood pressure was 180/87 mmHg. Echocardiography parameters were normal at baseline, and dobutamine stress echocardiography images revealed normal recruitment of systolic function with no evidence of ischemia.

interpretation. Correct image orientation is essential to accurate diagnoses. In turn, accurate interpretation and diagnosis depends chiefly on experience of the sonographer in acquiring images and on the expertise of the physician interpreting them. Therefore, it is essential that the interpreting physician have a complete understanding of resting transthoracic principles prior to gaining experience with stress echocardiography.

In summary, stress echocardiography is a routine diagnostic procedure for the initial assessment of coronary artery disease, the follow up of patients with known coronary artery disease, and for management decisions regarding revascularization in patients with chronic coronary disease. It is a powerful tool in the assessment of regional and overall myocardial function in skilled hands. As its use broadens, new applications are emerging, such as the assessment of valvular disease and contrast myocardial perfusion, continuing to expand this already versatile modality.

suggested reading

Cerqueira MD, Weissman NJ, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. Circulation 2002;105:539-542. Eagle KA, Brundage BH, Chaitman BR. Guidelines for perioperative cardiovascular evaluation for noncardiac surgery. J Am Coll Cardiol 1996;27:910-948. Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. Circulation 1999;99:2829-2848. Jong-Won H, Juracan EM, Mahoney DW, et al. Hypertensive response to exercise: a potential cause for new wall motion abnormality in the absence of coronary artery disease. J Am Coll Cardiol 2002;39:323-327. Shan K, Nagueh SF, Zoghbi WA. Assessment of myocardial viability with stress echocardiography. Cardiol Clin 1999;17:539-553.

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