American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography.

Methodology...... ..............................................1021 Imaging Equipment and Technique............1021 Stress Testing Methods...... ............................1022 Training Requirements and Maintenance of Competency...... .....................................1023 Image Interpretation......................................1024 Table 1. Normal and Ischemic Responses for Various Modalities of Stress........................................................1025 Quantitative Analysis Methods.....................1025 Accuracy...... .....................................................1026 False-negative Studies...... ..............................1026 False-positive Studies...... ...............................1027 Assessment of Myocardial Viability.............1027 Assessment of Patients With Dyspnea, Pulmonary Hypertension, and Valvular Heart Disease...... ........................1028 Dyspnea............................................................1028 Pulmonary Hypertension..............................1029 Mitral Valve Disease...... .................................1029 Aortic Valve Disease...... .................................1029 Evaluation of Prosthetic Valves....................1030 Stress Echocardiography for Risk Stratification................................................1030 Table 2. Summary of Studies Evaluating the Value of Stress Echocardiography in Predicting Outcome...... ........................1031 Table 3. Stress Echocardiography Predictors of Risk.......................................1032 Women..............................................................1032 After Acute Myocardial Infarction...... .........1032 Elderly...............................................................1033 Patients With Diabetes Mellitus...... .............1033 Before Noncardiac Surgery...... .....................1033 After Coronary Revascularization...... .........1033 Patients With Angina...... ...............................1033 Comparison With Radionuclide Imaging...... ....1033 Recent and Future Developments...... .........1034 Strain and Strain Rate Echocardiograpy...... ......1034 Three-Dimensional Echocardiography...... ........1034 Myocardial Contrast Perfusion Imaging...... ......1034 Summary...... ....................................................1034 References........................................................1034 Advances since the 1998 publication of the Recommendations for Performance and Interpretation of Stress Echocardiography include improvements in imaging equipment, refinements in stress testing protocols and standards for image interpretation, and important progress toward quantitative analysis. Moreover, the roles of stress echocardiography for cardiac risk stratification and for assessment of myocardial viability are now well documented. Specific recommendations and main points are identified in bold.