IMR Press / RCM / Volume 23 / Issue 8 / DOI: 10.31083/j.rcm2308275
Open Access Review
Exercise Stress Echocardiography for Stable Coronary Artery Disease: Succumbed to the Modern Conceptual Revolution or Still Alive and Kicking?
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1 Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
2 Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, 20122 Milan, Italy
3 Department of Health Sciences, University of Milan, 20122 Milan, Italy
4 Division of Cardiology, Azienda USL–IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
*Correspondence: (Andrea Barbieri)
Academic Editor: Michael Dandel
Rev. Cardiovasc. Med. 2022, 23(8), 275;
Submitted: 23 May 2022 | Revised: 13 June 2022 | Accepted: 15 June 2022 | Published: 26 July 2022
(This article belongs to the Special Issue Cardiac Stress Testing)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

The modern conceptual revolution in managing patients with stable coronary artery disease (CAD), based on improvement in preventive and pharmacological therapy, advocates coronary artery revascularization only for smaller group of patients with refractory angina, poor left ventricular systolic function, or high-risk coronary anatomy. Therefore, our conventional wisdom about stress testing must be questioned within this new and revolutionary paradigm. Exercise stress echocardiography (ESE) is still a well-known technique for assessing known or suspected stable CAD, it is safe, accessible, and well-tolerated, and there is an widespread evidence base. ESE has been remarkably resilient throughout years of innovation in noninvasive cardiology. Its value is not to be determined over the short portion of diagnostic accuracy but mainly through its prognostic value evident in a wide range of patient subsets. It is coming very close to the modern profile of a leading test that should include, in addition to an essential accettable diagnostic and prognostic accuracy, qualities of low cost, no radiation exposure, and minor environmental traces. In this review, we will discuss advantages, diagnostic accuracy, prognostic value in general and special populations, cost-effectiveness, and changes in referral patterns of ESE in the modern era.

exercise stress echocardiography
coronary artery disease
functional tests
Fig. 1.
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