Stress echocardiography

Monophasic response	Improvement in wall motion by one grade in two or more segments
Biphasic response	Improvement in wall motion abnormality at low dose dobutamine and subsequent worsening at higher doses
Suggestion of viability	Monophasic response
Suggestion of viability and ischemia	Biphasic response
Most predictive of functional recovery after revascularization	Biphasic response
Highest sensitivity for viability	Monophasic response
Highest specificity for viability	Biphasic response
False negatives	Single vessel disease -LCX lesion; inferolateral wall (use apical long axis) Suboptimal stress Concentric remodeling
False positives	Hypertensive response HCM Microvascular disease Tethering of stationary mitral valve (MAC/MVR): basal segments appear hypo/akinetic LBBB/pacing Post bypass: basal anteroseptum appears hypo/akinetic
False positive EKG stress test	Women Men on estrogen Digoxin therapy
EKG stress test- cannot report ischemia in	LBBB RBBB- if ST-T changes seen only in septal leads

Exercise/ Dobutamine stress echo in severe CAD (From Oh Manual)                      

	Exercise	Dobutamine
WM abnormalities	Multiple	Multiple
LV cavity	Dialtes	Usually does not dilate
LVEF	Decreases	May not decrease
ST segment depression	Common	Uncommon
Hypotension	Specific	Non specific

*LV end systolic volume may not decrease during bicycle stress echo (due to increased venous return)