Intraoperative Stress Echocardiography

Abstract

Echocardiography at rest is used to detect both chronic and acute coronary artery disease (CAD). It can also be used to identify mechanical complications of myocardial infarction and provides prognostic information by analyzing systolic and diastolic ventricular function. Segmental wall motion abnormalities (SWMA) are characteristic of scarred or ischemic tissue. Stress testing, e.g. dobutamine stress echocardiography (DSE), is able to detect and assess the severity of CAD. Low-dose DSE detects viable but not contractile myocardium in patients with SWMA at rest, whereas high-dose DSE reveals demand ischemia in patients without SWMA at rest. Perioperatively, echocardiography is usually performed by the transesophageal approach. It is used to monitor high-risk cardiac patients during cardiac and noncardiac surgery, to establish or confirm a cardiovascular pathology in emergency cases, to guide therapy in intraoperative hemodynamic instability and to assess the results of reconstructive cardiac surgery. Intraoperative transesophageal DSE (TEDSE) is a safe and accurate test with a high sensitivity and specificity to detect demand ischemia. It can be used for risk stratification in urgent noncardiac surgery and in patients with an increased risk of cardiac complications. Furthermore, intraoperative TEDSE can guide therapeutic management during and after coronary bypass grafting by the assessment of myocardial viability and coronary flow reserve. Finally, TEDSE can serve as a research tool to evaluate demand ischemia in CAD with a high sensitivity and specificity.