Coronary artery disease — diagnosis of ischaemia: general considerations

Stress echocardiography is a well established tool for the diagnosis of coronary artery disease. It combines the pro-vocation of myocardial ischaemia (either dynamic or non-dynamic) with images of the left ventricle obtained by two-dimensional echocardiography. Different modalities can be used to unmask coronary artery disease: increase of myo-cardial oxygen demand (exercise, pacing, or dobutamine) or reduction in oxygen supply (dipyridamole). Each form of stress has its distinct characteristics such as haemodynamic changes, accuracy, feasibility, and adverse effects, which specifically influence the decision 'which test for which patient'. Before engaging in the task of performing stress echocardi-ography, the cardiologist must have undergone special training under the supervision of an experienced stress echocardiographer, followed by an individual learning curve of 'try out ' studies without any diagnostic impact. While performing a stress echocardiographic examination one must always keep the history and risk profile of the individual patient in mind. These factors influence the pre-test likelihood of a patient having coronary artery disease, and therefore also the diagnostic merit of a stress test. While stress echocardiography is not the first test to be employed in patients with suspected coronary artery dis-ease, it represents a diagnostic tool which, if used correctly, is likely to become the most important non-invasive technique in modern cardiology