LET’S TALK ABOUT ECHO-STRESS

4 Jun 2019 News

ECHO-CARDIOGRAPH IS A FUNDAMENTAL NON-INVASIVE CARDIOLOGY METHOD WITHIN THE DIAGNOSTIC PATHWAYS OF A CARDIAC PATIENT OR AT RISK OF HEART DISEASE. IT IS A RAPID, LOW-COST, NON-INVASIVE, WITHOUT ADVERSE REACTIONS IMAGING METHOD.

Interviewee: Dr.Davide Maged MSc, Ph.D. in Biomedical Science and Public Health, Department of Public Health, Faculty of Medicine, Università Cattolica del Sacro Cuore Roma (Italy)

We interviewed Dr. Davide Maged to understand more about the effectiveness of this method. Dr. Davide, can you briefly introduce us to the principle on which the echocardiography is based?

Echocardiography is a non-invasive diagnostic method that uses ultrasound to visualize and explore the anatomy and function of the heart. When the coronary arteries (the arteries of the heart) are diseased or stenosis (restricted), the blood flow may be sufficient to allow the heart muscle to contract in conditions of rest, but, under conditions of stress it becomes insufficient causing an inadequate vascularization of the heart that contracts less and less or even stop. With an echocardiographic examination (echocardiogram), it is possible to evaluate the contraction of all the regions of the heart muscle at rest and during a physical or pharmacological stimulation.

This is an exam that is very popular today.

What are the warnings?

The spread of echocardiography in cardiovascular diagnostics, the multiple modalities of the examination (in basal conditions, during stress, during surgery) have led to the formalization of the guidelines for the certification and definition of the competences of the personnel who perform and interpret the echocardiographic examination and the characteristics of the equipment and of the cardiovascular ultrasound laboratories. This is defined by the ISO 9001 VISION 2000 certification.

Doctor, you mentioned different types of echocardiographic examinations. Among these is the exercise echocardiogram, called echo-stress. What is this about?

The echo-stress is an echocardiographic examination performed while exercising or with pharmacological stimulation. In the event that patients are not able to undergo a physical effort (exercise bike or treadmill), a drug is administered with a dosage established for age and body weight, which is progressively increasing. The pharmacological stimulus involves the acquisition of images at each increase in the dosage, allowing a step-by-step evaluation.

Can you describe how the test is carried out?

We have two kinds of examinations: the pharmacological one (infusion of medication at increasing doses) in which the patient is comfortably lying on the examination table and the exercise one, in which, as for the traditional echocardiogram, the patient lies bareback on a special table slightly inclined and is positioned on the left side. After having acquired the images at rest, we proceed progressively as for the examination with the bike to increase the workload that will progressively bring the heart to the maximum of its effort. The alterations induced during the stimulus are then evaluated and compared with the basal images. During the examination, the patient is subjected to continuous electrocardiographic (ECG), echocardiographic and pressure monitoring, in a protected environment equipped with emergency equipment.

Is echo-stress an alternative to other methods? Does the echo-stress provide an alternative to other methods?

 The echo-stress provides information comparable to exercise scintigraphy (invasive diagnostic examination using a radiopharmaceutical), but with a non-invasive examination, without contrast agents or radiation.

In a heart scintigraphy, the radiation is equal to 800/900 chest x-rays. Today we are reconsidering the echo-stress because from this examination you can have the same information with less risk and at a lower cost.

Today more and more people are sensitive to the suitability of the diagnostic indication. In fact, the patient does not have to undergo a series of examinations in order to be registered according to the case study. The examination to be carried out must be evaluated according to the real needs of the patient and his specific condition.

So in which cases is an echo-stress effective?

It is an examination used for patients with a suspected coronary artery disease or to assess the type of intervention in the case of patients with a severe reduction of the cardiac function due to a coronary artery disease, and finally in cases of the valvular disease, to control and measure the behavior of the valve and heart muscle during exercise. The examination, from the perspective of a surgical intervention, is essential for a detailed planning of the therapeutic path and the surgical intervention, to minimize the risk of complications in the operating phase and post-operative.

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