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Functional classification of children and adults with repaired and unrepaired congenital heart disease is a challenge for clinicians, due to the heterogeneity of congenital heart disease. Functional studies may be complemented with a stress echocardiogram, which analyzes the hemodynamic behavior of surgical repair zones, residuals, and sequelae. The integration of the anatomical and functional classification criteria developed for congenital heart disease and the results of a stress echocardiogram can establish a more precise functional classification. Stress echocardiograms also provide early diagnosis of functional complications of the congenital heart, allowing timely management decisions. This paper reviews the most important aspects of stress echocardiograms in pediatric and adult congenital heart disease, seeking to spark cardiologists’ interest in extending its applications in congenital heart disease.

The presence of angina with remarkably positive treadmill stress echocardiogram (TSE) carries a high specificity for flow-limiting coronary artery disease (CAD). However, angina due to aortic pathology is unusual. A 55 years old male with history of CAD and coronary artery bypass grafting

Anomalous aortic origin of a coronary artery (AAOCA) occurs in approximately 1% of coronary angiograms. Clinical manifestations include Sudden Cardiac Death (SCD) as well as ischemia and arrhythmias, especially during exercise and in those with an interarterial course between the aorta and the

Residual angina after PCI is a frequently-occurring disease. Ivabradine improves symptoms but its role in patients without left-ventricular systolic dysfunction is still unclear. The aim was to quantify the effects of ivabradine in terms of MVO2 indicators and diastolic function. Twenty-eight

Objetivo. El objetivo del presente trabajo se dirige a revisar las indicaciones, protocolos y aplicaciones del ecocardiograma de estrés.materiales y métodos. Con las palabras clave “ecocardiograma de estrés”, “ecocardiograma de esfuerzo” y “prueba de estres farmacológico” se hizo una búsqueda de información en la bases de datos de Pubmed/ Medline, Cochrane, SciELO, y en referencias de artículos de revistas y textos, principalmente de los últimos cinco años en inglés y en español. El resultado de esta búsqueda arrojó 203 referencias, de las cuales se tomaron las 46 más relevantes, teniendo en cuentra principalmente metanálisis, artículos de revision, actualizaciones, estudios aleatorios doble ciego y guías clínicas.Resultados. Los datos obtenidos de la función ventricular regional o global en el pico máximo de ejercicio son factores predictores importantes de eventos cardíacos, además de las variables clínicas, en el seguimiento de los pacientes. Un puntaje de motilidad parietal de esfuerzo mayor de 1,4 o una fracción de eyección de esfuerzo menor de 50%, implican un pronóstico significativamente adverso. Por otra parte, los indicadores de viabilidad miocárdica, mediante el estímulo farmacológico del miocardio, predicen la recuperación de la función cardiaca luego de los procedimientos de revascularización. Conclusión. El ecocardiograma de estrés es una técnica complementaria, útil para el diagnóstico y pronóstico del paciente con enfermedad coronaria. El fundamento de su uso consiste en que, al desencadenar isquemia, se produce una alteración de la motilidad parietal distal a la lesión coronaria obstructiva. Además, puede emplearse para evaluar la gravedad de una valvulopatía y para establecer el diagnóstico de la hipertensión pulmonar oculta. Objective: the objective of this Project is to review the indications, protocols and applications of the stress echocardiogram. methods and materials: research on the following words was done in the PUBMED/Medline, Cochrane, SciELO databases, as well as in references in journal articles and texts mainly from texts from the last five years in English and in Spanish: stress echocardiogram, effort echocardiogram and pharmacological stress test. The result of this search returned 203 references, 46 of which were taken as the most relevant, taking into consideration mainly, meth analysis, revision articles, state of the art, random studies, DOBLE CIEGO, and clinical guides. Results: The data obtained from the regional ventricular function in the maximum peak of exercise, are important predictors of cardiac events; this, in addition to all of the clinical variables during patient follow up. A score of parietal motility, higher than 1.4, or a ejection fraction lower than 50%, imply a significant adverse forecast. On the other hand, the myocardiál an viábility indicators, through the pharmacologic stimulus of the myocardium, predict the recovery of the cardiac function after revascularization procedures. Conclusion: The stress echocardiogram (ECO) is a complementary technique, useful for the diagnose and forecast fo patients with coronary disease. The principles of its use consist on the basics that upon the creation of ischemia, an alteration in the distal parietal motility will be produced to the obstructive coronary injury. Furthermore, it can be used to evaluate the severity of a vulvopathy and to establish the diagnose of the hidden pulmonary hypertension.

Background: Stress echocardiography (SE) is commonly used in ED patients with symptoms concerning for acute coronary syndrome (ACS). Prior studies have found the false positive (FP) rate of SE, as well as other stress testing modalities, in this setting, is greater than 50%. We sought to determine

Preexcitation syndromes pose a diagnostic challenge for exercise stress testing. We present stress echocardiographic findings in patient with Wolff–Parkinson–White (WPW) pattern on surface electrocardiogram (EKG). Echocardiogram at rest demonstrated paradoxical septal motion which disappeared during peak exercise and reappeared during rest. Preexcitation pattern on EKG also disappeared at peak stress. We tried to explain the underlying mechanisms of the above abnormality and the usefulness of stress testing in this group of patients.

Method:A resting and symptom limited stress echocardiogram was performed in 68 volunteers (38± 11 years). RV systolic function was estimated by ejection fraction (RVEF) and Doppler tissue imaging (DTI) tricuspid annular S′ velocity. Diastolic function was measured by tricuspid inflow peak E, E/A ratio and DTI E′ velocity. The relationship of RV parameters to age, preand postexercise were analysed. Results: Maximum heart rate and workload (METS) decreased with age. Whilst no change in RVEF was noted, RV S′ decreased with age at rest and post-exercise. The decrease in S′ per decade of life was more pronounced post-exercise (pre 0.7 cm/s/decade, post 2.0 cm/s/decade). A decrement in exercise induced augmentation of systolic function was noted by S′, but not by RVEF. RV diastolic function decreased significantly with age at rest and postexercise for tricuspid inflowE,E/A ratioandDTIE′ velocity. Conclusion: RV systolic and diastolic function are altered with normal ageing and these changes are accentuated with exercise. Additionally, DTImay be superior to conventional methods such as RVEF in identifying these changes. Variable Baseline Post-exercise