ECOCARDIOGRAFIA DE ESTRES




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ECOCARDIOGRAFIA DE ESTRES

(especial para SIIC © Derechos reservados)
La ecocardiografía de estrés es la mejor modalidad para lograr imágenes cardíacas en el campo del diagnóstico no invasivo de la enfermedad coronaria.
Autor:
Eugenio Picano
Columnista Experto de SIIC

Institución:
CNR, Institute of Clinical Physiology


Artículos publicados por Eugenio Picano
Recepción del artículo
19 de Agosto, 2004
Aprobación
24 de Agosto, 2004
Primera edición
1 de Julio, 2005
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
La ecocardiografía de estrés es la combinación de ecocardiografía bidimensional con estrés físico, farmacológico o eléctrico. El criterio diagnóstico de valoración para la detección de isquemia miocárdica es la inducción de un empeoramiento transitorio en la función regional durante el estrés. La ecocardiografía de estrés aporta precisión diagnóstica y pronóstica similares a las imágenes de perfusión con radionucleidos y estrés, pero a un costo notablemente menor, sin impactos en el medio ambiente y sin peligro biológico para el paciente o el facultativo. Entre los diferentes tipos de estrés con precisión diagnóstica y pronóstica similar, el ejercicio semisupino es el más utilizado, la dobutamina es la mejor prueba para evaluar la viabilidad miocárdica y el dipiridamol es el estrés farmacológico más sencillo, seguro y el más adecuado para la evaluación combinada de la motilidad de las paredes y la reserva del flujo coronario. El beneficio clínico adicional de la ecocardiografía miocárdica contrastada, de las imágenes Doppler tisulares y de la ecocardiografía tridimensional en tiempo real han sido contradictorios y decepcionantes, considerando que la adición de la evaluación de la reserva del flujo coronario de la arteria coronaria descendente anterior izquierda a través de la ecocardiografía Doppler transtorácica agrega otra dimensión potencialmente importante a la ecocardiografía de estrés. A pesar de su independencia en relación con el entrenamiento del operador, la ecocardiografía de estrés es, en la actualidad, la mejor posibilidad por imágenes para lograr el aún evasivo blanco de las imágenes cardíacas perdurables en el campo del diagnóstico no invasivo de la enfermedad coronaria.

Palabras clave
Diagnóstico, dipiridamol, ejercicio, ecocardiografía de estrés, enfermedad coronaria


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Abstract
Stress echocardiography is the combination of 2D echocardiography with a physical, pharmacological or electrical stress. The diagnostic end point for the detection of myocardial ischemia is the induction of a transient worsening in regional function during stress. Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician. Among different stresses of comparable diagnostic and prognostic accuracy, semisupine exercise is the most used, dobutamine the best test for viability, and dipyridamole the safest and simplest pharmacological stress and the most suitable for combined wall motion – coronary flow reserve assessment. The additional clinical benefit of myocardial contrast echocardiography, tissue Doppler imaging and real time 3-D echocardiography has been inconsistent and disappointing, whereas the potential of adding coronary flow reserve evaluation of left anterior descending coronary artery by transthoracic Doppler echocardiography adds another potentially important dimension to stress echocardiography. In spite of its dependence upon operator’s training, stress echocardiography is today the best possible imaging choice to achieve the still elusive target of sustainable cardiac imaging in the field of noninvasive diagnosis of coronary artery disease.

Key words
Diagnosis, dipyridamole, exercise, stress echocardiography, coronary artery disease


Full text
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Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Cardiología, Diagnóstico por Imágenes
Relacionadas: Cardiología, Diagnóstico por Imágenes, Farmacología, Medicina Interna



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Bibliografía del artículo
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Título español
Resumen
 Palabras clave
 Bibliografía
 Artículo completo
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