Inspanningsecho

Inspanningsecho, also known as stress echocardiography, is a cardiac imaging test that uses ultrasound to assess heart function under stress. It combines transthoracic echocardiography with either physical exercise, typically a treadmill or bicycle, or pharmacologic agents to simulate increased myocardial demand. The test evaluates left ventricular wall motion, global function, valvular function, and hemodynamics, with the aim of detecting ischemia and guiding management.

At rest, standard images are obtained. During exercise or pharmacologic provocation, images are repeated at peak stress and during recovery. In exercise protocols, a target heart rate is sought. In pharmacologic protocols, dobutamine or vasodilators may be used. Continuous monitoring of ECG and blood pressure occurs, and symptoms are recorded. Interpretation compares stressed and resting images; development of new or worsened regional wall motion abnormalities indicates inducible ischemia.

Indications include chest pain evaluation and suspected coronary artery disease, risk stratification before non-cardiac surgery, assessment of functional reserve in heart failure or valvular disease, and viability assessment in select patients. A normal stress echo suggests a low likelihood of significant obstructive CAD, while a positive test localizes ischemia and can guide therapy decisions such as revascularization.

Advantages include no ionizing radiation, real-time functional assessment, and the ability to evaluate contractile reserve and valvular dynamics, with wide availability. Limitations include image quality dependence on body habitus and lung disease, lower sensitivity for multivessel disease compared with nuclear testing, and the requirement for patient ability to exercise or tolerate pharmacologic stress; interpretation also relies on operator experience.

Safety is generally favorable with rare complications. Guidelines from professional bodies provide standardized protocols and interpretation criteria.