ECOCARDIOGRAMA DE STRESS Utilidad clínica Diagnóstico de cardiopatía isquémica. Seguimiento de pacientes valvulares. The focus of this lecture will be on describing the clinical applications of stress echocardiography in CAD and valvular heart disease, and focusing on the technical considerations in the performance and interpretation of these tests.

MODALIDADES DE STRESS EJERCICIO Cinta rodante Bicicleta Bicicleta supino Hand grip Ejercicio isométrico FARMACOLÓGICO Dobutamina Arbutamina Dipiridamol Adenosina Pacing This is just a summary of the various stress modalities that have been utilized with stress echocardiography. Both exercise and non-exercise modalities have been utilized. Most common exercise modality is treadmill, although bicycle has also been utilized. Hand grip and arm ergometry are rarely used these days. Dobutamine is the most common non-exercise based stressor, although adenosine and pacing are also utilized.

Respuesta normal al stress Mejoría global de la contractilidad. Disminución del volumen telesistólico final. Mejoría de la contractilidad regional. Aumento de la excursión endocárdica engrosamiento miocárdico. In order to interpret a stress echocardiogram, we need to know what a normal echocardiographic response to stress is. What we expect to see is A global improvement in LV contractility 2) A decrease in end-systolic volume 3) Improvement in regional LV contractility- with increased endocardial excursion and myocardial thickening.

Cascada isquémica Defecto de perfusión Disfuncion Diastolica Base Mid Apex Defecto de perfusión Disfuncion Diastolica Indices de Isquemia Disfuncion Sistolica Regional Alteraciones ECG Dolor torácico Duracion del ejercicio

Respuesta isquémica Disfunción sistólica Regional Disminución de la excursion endocárdca Disminución del engrosamiento de la pared. Retraso en la contracción (tardoquinesis) Disminución global de la FE Depende de la precarga y de la postcarga If we focus on systolic dysfunction What we see with regional LV dysfunction is a decrease in endocardial excursion, a decrease in wall thickening (which is a more specific marker of ischemia) or a delay in contraction (or tardokinesis) A global decline in ejection fraction can be an indicator of 3 vessel disease, but this can be affected by variations in pre-load and afterload.

Modelo de 16 segmentos CD Eje largo Eje corto DA DA (PROX) CX Base Mid Anteroseptal Posterior Eje largo Eje corto LAX LAX A2C A2C A4C A4C DA DA (PROX) CX CD Base Mid Apex Septal Lateral Cuatro cámaras Apex Mid Base Anterior Inferior Dos cámaras

Interpretación Normal Hyperquinetica No cambios Hypoquinetica Normal Variable Isquemia Isquemia Bajo stress Retraso imágenes Beta-bolqueantes Hypertension

Interpretación Aquinetica Mejoría No cambios Disquinetica Viable Hypoquinetica Hyperquinetica No cambios Aquinetica Variable Necrosis Infarto +/- Isc Normal Viable Miopatia Aquinetica Mejoría No cambios Disquinetica Viable Tethering Necrosis Necrosis (Dobut) (Ejercicio)

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