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Guidelines for Performance, Interpretation, and …

Guidelines AND STANDARDSG uidelines for performance , Interpretation, and Application of Stress Echocardiographyin Ischemic Heart Disease: From theAmerican society of EchocardiographyPatricia A. Pellikka, MD, FASE, Chair, Adelaide Arruda-Olson, MD, PhD, FASE,Farooq A. Chaudhry, MD, FASE,*Ming Hui Chen, MD, MMSc, FASE, Jane E. Marshall, RDCS, FASE,Thomas R. Porter, MD, FASE, and Stephen G. Sawada, MD,Rochester, Minnesota; New York, New York; Boston,Massachusetts; Omaha, Nebraska; Indianapolis, IndianaKeywords: echocardiography , Stress, Guidelines , Imaging, Ischemic heart disease, Stress test, PediatricsTABLE OF CONTENTSI. Introduction 3II. Methodology 3a. Imaging 3b. Format for Image Display 5c. Use of an Ultrasound Enhancing Agent 7 III. Stress Testing Methods 8a.

*The American Society of Echocardiography and the Writing Group sadly note the passing of Dr. Farooq A. Chaudhry in August 2017, while this document was being written. Itwasour honortoworkwithDr.Chaudhry onatopicthatwasverydearto him throughout his esteemed career. Reprint requests: American Society of Echocardiography, Meridian Corporate

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Transcription of Guidelines for Performance, Interpretation, and …

1 Guidelines AND STANDARDSG uidelines for performance , Interpretation, and Application of Stress Echocardiographyin Ischemic Heart Disease: From theAmerican society of EchocardiographyPatricia A. Pellikka, MD, FASE, Chair, Adelaide Arruda-Olson, MD, PhD, FASE,Farooq A. Chaudhry, MD, FASE,*Ming Hui Chen, MD, MMSc, FASE, Jane E. Marshall, RDCS, FASE,Thomas R. Porter, MD, FASE, and Stephen G. Sawada, MD,Rochester, Minnesota; New York, New York; Boston,Massachusetts; Omaha, Nebraska; Indianapolis, IndianaKeywords: echocardiography , Stress, Guidelines , Imaging, Ischemic heart disease, Stress test, PediatricsTABLE OF CONTENTSI. Introduction 3II. Methodology 3a. Imaging 3b. Format for Image Display 5c. Use of an Ultrasound Enhancing Agent 7 III. Stress Testing Methods 8a.

2 Exercise Stress Testing 8b. Pharmacologic Stress Testing 9 This document is endorsed by the following ASE International Alliance Partners: Argentine Federation ofCardiology, Argentine society of Cardiology, ASEAN society of echocardiography , Association ofEchocardiographyandCardiovascularImagi ngoftheInteramericanSocietyofCardiology, AustralasianSonographersAssociation, Canadian society of echocardiography , Chinese society of echocardiography , Cuban society ofCardiography echocardiography Section, Department ofCardiovascular Imaging of the Brazilian society ofCardiology, Indian Academy of echocardiography , Indian Association of Cardiovascular Thoracic Anaesthesiologists,Indonesian society of echocardiography , Iranian society of echocardiography , Israeli Working Group onEchocardiography, Italian Association of CardioThoracicand Vascular Anaesthesia and Intensive Care.

3 JapaneseSociety of echocardiography , Korean society of echocardiography , Mexican society of echocardiography andCardiovascular Imaging, National Association of Cardiologists of Mexico, National society of echocardiography ofMexico, Philippine society of echocardiography , Saudi Arabian society of echocardiography , Venezuelan society ofCardiology, Vietnamese society of Mayo Clinic, Rochester, Minnesota ( and ); Icahn School ofMedicine at Mount Sinai, New York, New York ( ); Boston Children sHospital, Harvard Medical School, Boston, Massachusetts ( );Massachusetts General Hospital, Boston, Massachusetts ( ); University ofNebraska Medical Center, Omaha, Nebraska ( ); Indiana University Schoolof Medicine, Indianapolis, Indiana ( ).The following authors reported no actual or potential conflicts of interest in relationto this document: Ming Hui Chen, MD, MMSc, FASE; Jane E.

4 Marshall, RDCS,FASE; Stephen G. Sawada, MD. The following authors reported relationshipswith one or more commercial interests: Farooq A. Chaudhry, MD, FASE, receiveda research grant, a restricted fellowship grant, and consulted for Bracco Diagnos-tics, a research grant from GE Healthcare, and consulted for Lantheus Medical Im-aging; Patricia A. Pellikka, MD, FASE, served on the advisory board for BraccoDiagnostics and received research grants from GE Healthcare and Lantheus Med-ical Imaging, with money paid to her institution; Thomas R. Porter, MD, FASE,received a research grant and served on the speaker s bureau for Bracco Diagnos-tics, and received a research grant from Lantheus Medical Imaging. Dr. AdelaideArruda-Olson was supported by the National Heart, Lung, and Blood Institute ofthe National Institutes of Health (award K01HL124045).

5 The content is solely theresponsibility of the authors and does not necessarily represent the official viewsof the National Institutes of Health.*The american society of echocardiography and the Writing Group sadly note thepassing of Dr. Farooq A. Chaudhry in August 2017, while this document was beingwritten. It was our honor to work with Dr. Chaudhry on a topic that was very dear tohim throughout his esteemed requests: american society of echocardiography , Meridian CorporateCenter, 2530 Meridian Parkway, Suite 450, Durham, NC 27713 ASE earn free continuing medical education creditthrough an online activity related to this article. Certificates are available for im-mediate access upon successful completion of the activity. Nonmembers willneed to join the ASE to access this great member benefit!

6 0894-7317/$ 2019 Published by Elsevier Inc. on behalf of the american society Image interpretation 10a. Pathophysiology and Detection of Regional Wall MotionAbnormalities in Coronary Disease 10b. Grading of Regional Function 11c. Assessment During Stress and in Recovery 11d. Assessment of Right Ventricular Function 12e. Modality-specific Differences in the Regional and Global LeftVentricular Response to Stress 13f. Reporting 13g. Perfusion Imaging Assessment with Ultrasound EnhancingAgent 14V. Quantitative Analysis Methods 15VI. Accuracy 19a. Blood Pressure Response to Stress 19b. Microvascular Disease 20c. Impact of Perfusion Imaging 20d. Coronary Flow Reserve 20e. Three-Dimensional Stress echocardiography 20 VII. Risk Stratification and Prognosis 21a.

7 Extent and Severity of Wall Motion Abnormalities 21b. Transient Ischemic LV Dilatation 21c. RV Ischemia 21d. Stress echocardiography in Patients with Dyspnea 22e. Stress echocardiography in Patients with Left Bundle BranchBlock 22f. Preoperative Risk Stratification 23g. Impact of Contrast on Prognosis 24 VIII. Assessment of Myocardial Viability 24a. Assessment of Contractile Reserve 24b. DSE Protocols for Assessing Viability 24c. interpretation of Wall Motion Response for Assessment ofViability 25d. Accuracy of DSE for Detection of Viability 25e. Quantitative Methods for Assessment of Viability 25f. Current Considerations in Assessment of Viability 26IX. Comparison with Other Imaging Modalities 26X. Radiation-Induced Coronary Artery Disease 28XI.

8 Stress echocardiography in Pediatric Patients and Congenital HeartDisease 28a. Pediatric Cardiac Transplantation 28 AbbreviationsACC= american College of CardiologyAQ= Acoustic quantificationASE= american society of EchocardiographyASO= Arterial switch operationBP= Blood pressureCABG= Coronary artery bypass graftingCAD= Coronary artery diseaseCK= Color kinesisCMR= Cardiac magnetic resonanced-TGA= Dextro-loop transposition of the great arteriesDSE= Dobutamine stress echocardiographyECG= ElectrocardiogramEF= Ejection fractionESE= Exercise stress echocardiographyFFR= Fractional flow reserveHR= Heart rateICU= Intensive care unitIHD= Ischemic heart diseaseKD= Kawasaki diseaseLA= Left atrialLAD= Left anterior descending coronary arteryLBBB= Left bundle branch blockLDL= Low-density lipoproteinLV= Left ventricular/ventricleLVO= Left ventricular

9 OpacificationLVOT= Left ventricular outflow tractMACE= Major adverse cardiovascular eventMI= Mechanical indexMR= Mitral regurgitationMRI= Magnetic resonance imagingmSv= MillisievertsPET= Positron emission tomographyPROMISE= Prospective Multicenter Imaging Study for Evaluationof Chest PainPSS= Post-systolic shorteningPW= Pulsed-waveROC= Receiver-operator curvesRTMCE= Real-time myocardial contrast echocardiographyRV= Right ventricularRWM= Regional wall motionSPECT= Single-photon emission computed tomographySTE= Speckle-tracking echocardiographySTICH= Surgical Treatment of Ischemic Heart FailureTAPSE= Tricuspid annular plane systolic excursionTDI= Tissue Doppler imagingTR= Tricuspid regurgitationTTE= Transthoracic echocardiogramsUEA= Ultrasound enhancing agentsVLMI= Very low MIWMSI= Wall motion score index2D= Two-dimensional3D= Three-dimensional2 Pellikka et alJournal of the american society of EchocardiographyJanuary 2020b.

10 Kawasaki Disease 28c. Anomalous Origin of a Coronary Artery 31d. Transposition of the Great Arteries, Status Post Arterial SwitchOperation 31e. Familial Hypercholesterolemia 31 XII. Training Requirements and Maintenance of Competency 31a. Sonographer Training 31b. Physician Training 31c. Training for Contrast Perfusion Imaging 32d. Training for Pediatric Stress echocardiography 32 XIII. Appropriate Use Criteria and Stress echocardiography 32 XIV. Summary 32I. INTRODUCTIONS ince the 2007 publication of the american society ofEchocardiography (ASE) Guidelines for stress echocardiography ,1new information has become available about the methodology ofstress echocardiography , including test protocols, standards for inter-pretation (including quantitative methods of assessment and applica-tion of strain rate imaging), appropriateness of testing, comparisonwith other modalities for assessing ischemic heart disease (IHD), safetyof stress echocardiography , application of the technique in childrenand special populations, prognostic value, and role of ultrasoundenhancing agents (UEA) and perfusion imaging.


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