Chronic stable angina echocardiography: Difference between revisions

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/* Echocardiography (Rest) for Diagnosis of Cause of Chest Pain in Patients With Suspected Chronic Stable Angina Pectoris (DO NOT EDIT){{cite journal| author=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP et al.| title=2012 ACCF/AHA/A...
 
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__NOTOC__
{{Chronic stable angina}}
{{Chronic stable angina}}
'''Editors-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Associate Editor(s)-in-Chief:''' {{CZ}}; Smita Kohli, M.D.; [[Lakshmi Gopalakrishnan]], M.B.B.S.
 
'''Editors-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; '''Associate Editor(s)-In-Chief:''' {{CZ}}; Smita Kohli, M.D.; [[Lakshmi Gopalakrishnan|Lakshmi Gopalakrishnan, M.B.B.S.]]


==Overview==
==Overview==
Echocardiography is useful to evaluate '''ventricular function''' <ref name="pmid9091535">Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9091535 ACC/AHA guidelines for the clinical application of echocardiography: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography.] ''J Am Coll Cardiol'' 29 (4):862-79. PMID: [http://pubmed.gov/9091535 9091535]</ref> and detect '''ischemia induced regional wall motion abnormality''' that occurs at rest, during exercise or with pharmacologic stress test. Upright treadmill exercise and supine bicycle ergometry, pacing, and pharmacologic stress, particularly with [[dobutamine]], have been used in conjunction with [[two-dimensional echocardiography]] to detect regional wall motion abnormalities that most frequently occur during induced [[myocardial ischemia]] associated with [[CAD]]. In  patients with [[CAD]], the inability to perform a bicycle or exercise treadmill test per se is a poor prognostic factor.
Echocardiography is useful to evaluate ventricular function<ref name="pmid9091535">Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9091535 ACC/AHA guidelines for the clinical application of echocardiography: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography.] ''J Am Coll Cardiol'' 29 (4):862-79. PMID: [http://pubmed.gov/9091535 9091535]</ref> and detect ischemia induced regional wall motion abnormality that occurs at rest, during exercise or with pharmacologic stress test. As a testing modality, [[two-dimensional echocardiography]] is often coupled with other testing modalities to detect regional wall motion abnormalities that most frequently occur during induced [[myocardial ischemia]] associated with [[coronary artery disease|coronary artery disease (CAD)]]. Potential paired testing modalities include: upright treadmill exercise, supine bicycle ergometry, pacing, and pharmacologic stress, particularly with [[dobutamine]]. Patients with CAD may respond more adversely to testing modalities than their counterparts. Often, an adverse outcome such as the inability to perform a bicycle ergometry test or exercise treadmill protocol can be characterized as a poor prognostic factor.


==Indications==  
==Echocardiography==
*Echocardiography is typically useful in patients with murmurs <ref name="pmid10856408">Attenhofer Jost CH, Turina J, Mayer K, Seifert B, Amann FW, Buechi M et al. (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10856408 Echocardiography in the evaluation of systolic murmurs of unknown cause.] ''Am J Med'' 108 (8):614-20. PMID: [http://pubmed.gov/10856408 10856408]</ref>, previous [[MI]] <ref name="pmid11686666">Marchioli R, Avanzini F, Barzi F, Chieffo C, Di Castelnuovo A, Franzosi MG et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11686666 Assessment of absolute risk of death after myocardial infarction by use of multiple-risk-factor assessment equations: GISSI-Prevenzione mortality risk chart.] ''Eur Heart J'' 22 (22):2085-103. [http://dx.doi.org/10.1053/euhj.2000.2544 DOI:10.1053/euhj.2000.2544] PMID: [http://pubmed.gov/11686666 11686666]</ref>, history and ECG changes suggestive of [[Hypertrophic cardiomyopathy diagnostic testing#Echocardiography|hypertrophic cardiomyopathy]] <ref name="pmid11447072">Nagueh SF, Bachinski LL, Meyer D, Hill R, Zoghbi WA, Tam JW et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11447072 Tissue Doppler imaging consistently detects myocardial abnormalities in patients with hypertrophic cardiomyopathy and provides a novel means for an early diagnosis before and independently of hypertrophy.] ''Circulation'' 104 (2):128-30. PMID: [http://pubmed.gov/11447072 11447072]</ref>.
===Indications===
*Regardless of the etiology, '''diastolic dysfunction''' has a major impact on the functional status, treatment and prognosis of heart failure.
*Echocardiography is typically useful in patients with murmurs,<ref name="pmid10856408">Attenhofer Jost CH, Turina J, Mayer K, Seifert B, Amann FW, Buechi M et al. (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10856408 Echocardiography in the evaluation of systolic murmurs of unknown cause.] ''Am J Med'' 108 (8):614-20. PMID: [http://pubmed.gov/10856408 10856408]</ref> previous [[MI]]<ref name="pmid11686666">Marchioli R, Avanzini F, Barzi F, Chieffo C, Di Castelnuovo A, Franzosi MG et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11686666 Assessment of absolute risk of death after myocardial infarction by use of multiple-risk-factor assessment equations: GISSI-Prevenzione mortality risk chart.] ''Eur Heart J'' 22 (22):2085-103. [http://dx.doi.org/10.1053/euhj.2000.2544 DOI:10.1053/euhj.2000.2544] PMID: [http://pubmed.gov/11686666 11686666]</ref> history and ECG changes suggestive of [[Hypertrophic cardiomyopathy diagnostic testing#Echocardiography|hypertrophic cardiomyopathy]].<ref name="pmid11447072">Nagueh SF, Bachinski LL, Meyer D, Hill R, Zoghbi WA, Tam JW et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11447072 Tissue Doppler imaging consistently detects myocardial abnormalities in patients with hypertrophic cardiomyopathy and provides a novel means for an early diagnosis before and independently of hypertrophy.] ''Circulation'' 104 (2):128-30. PMID: [http://pubmed.gov/11447072 11447072]</ref>
:*There is also an independent association observed between diastolic heart failure and history of [[ischemic heart disease]], further emphasizing the use of echocardiography in patients with signs and symptoms suggestive of [[Congestive heart failure imaging modalities#heart failure|heart failure]] <ref name="pmid12958001">O'Mahony MS, Sim MF, Ho SF, Steward JA, Buchalter M, Burr M (2003)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12958001 Diastolic heart failure in older people.] ''Age Ageing'' 32 (5):519-24. PMID: [http://pubmed.gov/1295800112958001]</ref> <ref name="pmid15542421">Fonseca C, Mota T, Morais H, Matias F, Costa C, Oliveira AG et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15542421 The value of the electrocardiogram and chest X-ray for confirming or refuting a suspected diagnosis of heart failure in the community.] ''Eur J Heart Fail'' 6 (6):807-12, 821-2. [http://dx.doi.org/10.1016/j.ejheart.2004.09.004 DOI:10.1016/j.ejheart.2004.09.004] PMID: [http://pubmed.gov/15542421 15542421]</ref>.
*Regardless of the etiology, diastolic dysfunction has a major impact on the functional status, treatment and prognosis of heart failure.
:*Resting echocardiography, doppler imaging and strain rate measurement <ref name="pmid14652617">Yip G, Abraham T, Belohlavek M, Khandheria BK (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14652617 Clinical applications of strain rate imaging.] ''J Am Soc Echocardiogr'' 16 (12):1334-42. [http://dx.doi.org/10.1067/j.echo.2003.09.004 DOI:10.1067/j.echo.2003.09.004] PMID: [http://pubmed.gov/14652617 14652617]</ref> have improved the ability to identify undetected diastolic dysfunction <ref name="pmid1768877">Beattie RC, Spence J (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1768877 Auditory brainstem response to clicks in quiet, notch noise, and highpass noise.] ''J Am Acad Audiol'' 2 (2):76-90. PMID: [http://pubmed.gov/1768877 1768877]</ref> in chronic stable angina patients without [[heart failure]].
:*There is also an independent association observed between diastolic heart failure and history of [[ischemic heart disease]], further emphasizing the use of echocardiography in patients with signs and symptoms suggestive of [[Congestive heart failure imaging modalities#heart failure|heart failure]].<ref name="pmid12958001">O'Mahony MS, Sim MF, Ho SF, Steward JA, Buchalter M, Burr M (2003)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12958001 Diastolic heart failure in older people.] ''Age Ageing'' 32 (5):519-24. PMID: [http://pubmed.gov/1295800112958001]</ref><ref name="pmid15542421">Fonseca C, Mota T, Morais H, Matias F, Costa C, Oliveira AG et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15542421 The value of the electrocardiogram and chest X-ray for confirming or refuting a suspected diagnosis of heart failure in the community.] ''Eur J Heart Fail'' 6 (6):807-12, 821-2. [http://dx.doi.org/10.1016/j.ejheart.2004.09.004 DOI:10.1016/j.ejheart.2004.09.004] PMID: [http://pubmed.gov/15542421 15542421]</ref>
:*Resting echocardiography, doppler imaging and strain rate measurement<ref name="pmid14652617">Yip G, Abraham T, Belohlavek M, Khandheria BK (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14652617 Clinical applications of strain rate imaging.] ''J Am Soc Echocardiogr'' 16 (12):1334-42. [http://dx.doi.org/10.1067/j.echo.2003.09.004 DOI:10.1067/j.echo.2003.09.004] PMID: [http://pubmed.gov/14652617 14652617]</ref> have improved the ability to identify undetected diastolic dysfunction<ref name="pmid1768877">Beattie RC, Spence J (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1768877 Auditory brainstem response to clicks in quiet, notch noise, and highpass noise.] ''J Am Acad Audiol'' 2 (2):76-90. PMID: [http://pubmed.gov/1768877 1768877]</ref> in chronic stable angina patients without [[heart failure]].


==ACC / AHA Guidelines- Echocardiography at Rest (DO NOT EDIT)<ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. PMID: [http://pubmed.gov/10351980 10351980]</ref>==
==ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)<ref name="pmid23166210">{{cite journal| author=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP et al.| title=2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2012 | volume= 126 | issue= 25 | pages= 3097-137 | pmid=23166210 | doi=10.1161/CIR.0b013e3182776f83 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23166210  }} </ref>==
{{cquote|
===Class I===
'''1.''' Patients with a [[systolic murmur]] suggestive of [[aortic stenosis]] and/or [[hypertrophic cardiomyopathy]]. ''(Level of Evidence: C)''


'''2.''' Evaluation of extent (severity) of [[ischemia]] (eg, [[LV]] segmental wall motion abnormality) when the [[echocardiogram]] can be obtained during pain or within 30 minutes after its abatement. ''(Level of Evidence: C)''
===Echocardiography (Rest) for Diagnosis of Cause of Chest Pain in Patients With Suspected Chronic Stable Angina Pectoris (DO NOT EDIT)<ref name="pmid23166210">{{cite journal| author=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP et al.| title=2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2012 | volume= 126 | issue= 25 | pages= 3097-137 | pmid=23166210 | doi=10.1161/CIR.0b013e3182776f83 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23166210  }} </ref>===
'''Patients able to exercise'''
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]


===Class IIb===
|-
'''1.''' Patients with a click and/or murmur to diagnose [[mitral valve prolapse]]. ''(Level of Evidence: C)''
| bgcolor="LightGreen"|
<nowiki>"</nowiki>'''1.''' Exercise stress with nuclear MPI or echocardiography is recommended for patients with an intermediate to high pretest probability
of IHD who have an uninterpretable ECG and at least moderate physical functioning or no disabling comorbidity  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}


===Class III===
{|class="wikitable"
'''1.''' Patients with a normal [[ECG]], no history of [[MI]], and no signs or symptoms suggestive of [[heart failure]], [[valvular heart disease]], or [[hypertrophic cardiomyopathy]]. ''(Level of Evidence: C)''}}
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]


==ESC Guidelines- Echocardiography for initial diagnostic assessment of angina (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==
|-
{{cquote|
| bgcolor="LemonChiffon"|
===Class I===
<nowiki>"</nowiki>'''1.''' Exercise stress with nuclear MPI or echocardiography is reasonable for patients with an intermediate to high pretest probability of
'''1.''' Patients with abnormal auscultation suggesting valvular heart disease or [[hypertrophic cardiomyopathy]]. ''(Level of Evidence: B)''
obstructive IHD who have an interpretable ECG and at least moderate physical functioning or no disabling comorbidity ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki>
|}


'''2.''' Patients with suspected [[heart failure]]. ''(Level of Evidence: B)''
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]


'''3.''' Patients with prior [[MI]]. ''(Level of Evidence: B)''
|-
| bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''1.''' For patients with a low pretest probability of obstructive IHD who do require testing, standard exercise stress echocardiography might be reasonable, provided the patient has an interpretable ECG and at least moderate physical functioning or no disabling comorbidity ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki>
|}


'''4.'''  Patients with [[LBBB]], [[Q waves]], or other significant pathological changes on ECG, including ECG [[LVH]]. ''(Level of Evidence: C)''}}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]


==Vote on and Suggest Revisions to the Current Guidelines==
|-
*[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
| bgcolor="LightCoral"|
<nowiki>"</nowiki>'''1.''' 1. Pharmacological stress with nuclear MPI, echocardiography, or CMR is not recommended for patients who have an interpretable
ECG and at least moderate physical functioning or no disabling comorbidity. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
'''Patients unable to exercise'''
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]


==Sources==
|-
*Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= |url=url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 [http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf]}} </ref>
| bgcolor="LightGreen"|
<nowiki>"</nowiki>'''1.''' Pharmacological stress with nuclear MPI or echocardiography is recommended for patients with an intermediate to high pretest probability of IHD who are incapable of at least moderate physical functioning or have disabling comorbidity  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}


*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref>
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]


*TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref>
|-
| bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''1.''' Pharmacological stress echocardiography is reasonable for patients with a low pretest probability of IHD who require testing and are incapable of at least moderate physical functioning or have disabling comorbidity. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])<nowiki>"</nowiki>
|}
'''Other'''
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]


*The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref>
|-
| bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''1.''' CCTA is reasonable for patients with an intermediate pretest probability of IHD who a) have continued symptoms with prior normal test findings, or b) have inconclusive results from prior exercise or pharmacological stress testing, or c) are unable to undergo stress with nuclear MPI or echocardiography. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])<nowiki>"</nowiki>
|}


==References==
==ESC Guidelines- Echocardiography for Initial Diagnostic Assessment of Angina (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==
{{Reflist|2}}


[[Category:Ischemic heart diseases]]
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[European society of cardiology#Classes of Recommendations|Class I]]


[[Category:Disease state]]
|-
[[Category:Cardiology]]
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Patients with abnormal auscultation suggesting valvular heart disease or [[hypertrophic cardiomyopathy]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
[[Category:Emergency medicine]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Patients with suspected [[heart failure]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Patients with prior [[MI]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' Patients with [[LBBB]], [[Q waves]], or other significant pathological changes on ECG, including ECG criteria for [[LVH]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}


[[Category:Up to date cardiology]]
==References==
[[Category:Up to date]]
{{reflist|2}}


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Latest revision as of 22:32, 29 October 2016

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Risk calculators and risk factors for Chronic stable angina echocardiography

Editors-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]; Smita Kohli, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

Echocardiography is useful to evaluate ventricular function[1] and detect ischemia induced regional wall motion abnormality that occurs at rest, during exercise or with pharmacologic stress test. As a testing modality, two-dimensional echocardiography is often coupled with other testing modalities to detect regional wall motion abnormalities that most frequently occur during induced myocardial ischemia associated with coronary artery disease (CAD). Potential paired testing modalities include: upright treadmill exercise, supine bicycle ergometry, pacing, and pharmacologic stress, particularly with dobutamine. Patients with CAD may respond more adversely to testing modalities than their counterparts. Often, an adverse outcome such as the inability to perform a bicycle ergometry test or exercise treadmill protocol can be characterized as a poor prognostic factor.

Echocardiography

Indications

  • Echocardiography is typically useful in patients with murmurs,[2] previous MI[3] history and ECG changes suggestive of hypertrophic cardiomyopathy.[4]
  • Regardless of the etiology, diastolic dysfunction has a major impact on the functional status, treatment and prognosis of heart failure.
  • There is also an independent association observed between diastolic heart failure and history of ischemic heart disease, further emphasizing the use of echocardiography in patients with signs and symptoms suggestive of heart failure.[5][6]
  • Resting echocardiography, doppler imaging and strain rate measurement[7] have improved the ability to identify undetected diastolic dysfunction[8] in chronic stable angina patients without heart failure.

ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)[9]

Echocardiography (Rest) for Diagnosis of Cause of Chest Pain in Patients With Suspected Chronic Stable Angina Pectoris (DO NOT EDIT)[9]

Patients able to exercise

Class I

"1. Exercise stress with nuclear MPI or echocardiography is recommended for patients with an intermediate to high pretest probability of IHD who have an uninterpretable ECG and at least moderate physical functioning or no disabling comorbidity (Level of Evidence: B)"

Class IIa

"1. Exercise stress with nuclear MPI or echocardiography is reasonable for patients with an intermediate to high pretest probability of obstructive IHD who have an interpretable ECG and at least moderate physical functioning or no disabling comorbidity (Level of Evidence: B)"

Class IIb

"1. For patients with a low pretest probability of obstructive IHD who do require testing, standard exercise stress echocardiography might be reasonable, provided the patient has an interpretable ECG and at least moderate physical functioning or no disabling comorbidity (Level of Evidence: B)"

Class III

"1. 1. Pharmacological stress with nuclear MPI, echocardiography, or CMR is not recommended for patients who have an interpretable ECG and at least moderate physical functioning or no disabling comorbidity. (Level of Evidence: C)"

Patients unable to exercise

Class I

"1. Pharmacological stress with nuclear MPI or echocardiography is recommended for patients with an intermediate to high pretest probability of IHD who are incapable of at least moderate physical functioning or have disabling comorbidity (Level of Evidence: B)"

Class IIa

"1. Pharmacological stress echocardiography is reasonable for patients with a low pretest probability of IHD who require testing and are incapable of at least moderate physical functioning or have disabling comorbidity. (Level of Evidence: C)"

Other

Class IIa

"1. CCTA is reasonable for patients with an intermediate pretest probability of IHD who a) have continued symptoms with prior normal test findings, or b) have inconclusive results from prior exercise or pharmacological stress testing, or c) are unable to undergo stress with nuclear MPI or echocardiography. (Level of Evidence: C)"

ESC Guidelines- Echocardiography for Initial Diagnostic Assessment of Angina (DO NOT EDIT)[10]

Class I
"1. Patients with abnormal auscultation suggesting valvular heart disease or hypertrophic cardiomyopathy. (Level of Evidence: B)"
"2. Patients with suspected heart failure. (Level of Evidence: B)"
"3. Patients with prior MI. (Level of Evidence: B)"
"4. Patients with LBBB, Q waves, or other significant pathological changes on ECG, including ECG criteria for LVH. (Level of Evidence: C)"

References

  1. ↑ Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ et al. (1997) ACC/AHA guidelines for the clinical application of echocardiography: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. J Am Coll Cardiol 29 (4):862-79. PMID: 9091535
  2. ↑ Attenhofer Jost CH, Turina J, Mayer K, Seifert B, Amann FW, Buechi M et al. (2000) Echocardiography in the evaluation of systolic murmurs of unknown cause. Am J Med 108 (8):614-20. PMID: 10856408
  3. ↑ Marchioli R, Avanzini F, Barzi F, Chieffo C, Di Castelnuovo A, Franzosi MG et al. (2001) Assessment of absolute risk of death after myocardial infarction by use of multiple-risk-factor assessment equations: GISSI-Prevenzione mortality risk chart. Eur Heart J 22 (22):2085-103. DOI:10.1053/euhj.2000.2544 PMID: 11686666
  4. ↑ Nagueh SF, Bachinski LL, Meyer D, Hill R, Zoghbi WA, Tam JW et al. (2001) Tissue Doppler imaging consistently detects myocardial abnormalities in patients with hypertrophic cardiomyopathy and provides a novel means for an early diagnosis before and independently of hypertrophy. Circulation 104 (2):128-30. PMID: 11447072
  5. ↑ O'Mahony MS, Sim MF, Ho SF, Steward JA, Buchalter M, Burr M (2003)Diastolic heart failure in older people. Age Ageing 32 (5):519-24. PMID: [1]
  6. ↑ Fonseca C, Mota T, Morais H, Matias F, Costa C, Oliveira AG et al. (2004) The value of the electrocardiogram and chest X-ray for confirming or refuting a suspected diagnosis of heart failure in the community. Eur J Heart Fail 6 (6):807-12, 821-2. DOI:10.1016/j.ejheart.2004.09.004 PMID: 15542421
  7. ↑ Yip G, Abraham T, Belohlavek M, Khandheria BK (2003) Clinical applications of strain rate imaging. J Am Soc Echocardiogr 16 (12):1334-42. DOI:10.1067/j.echo.2003.09.004 PMID: 14652617
  8. ↑ Beattie RC, Spence J (1991) Auditory brainstem response to clicks in quiet, notch noise, and highpass noise. J Am Acad Audiol 2 (2):76-90. PMID: 1768877
  9. ↑ 9.0 9.1 Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP; et al. (2012). "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 126 (25): 3097–137. doi:10.1161/CIR.0b013e3182776f83. PMID 23166210.
  10. ↑ Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.


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