The evolution of stress echocardiography

The feasibility of using echocardiography to identify stress induced wall motion abnormalities was first demonstrated with M-mode recordings. The practical use of such a test had to await the development of 2-dimensional echocardiography whereby more wall segments could be analyzed. From the early days of 2-dimensional echocardiography there have been a succession of technological and clinical advances which have made stress echocardiography a very clinically useful tool in the management of patients with known or suspected coronary artery disease. These developments included the realization that stress-induced wall motion abnormalities produce stunned myocardium permitting immediate posttreadmill echoes to be clinically useful, the use of pharmacologic stress, the introduction of digital recording techniques so that rest and stress images could be viewed side-by-side, and more recently the advent of new imaging technologies, such as harmonic imaging of tissue to provide higher quality of stress echocardiograms.