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ECHO 2013 / Stress Echocardiography

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Submax HR (75% MPHR)

Inf-post WMA at rest

Low dose - no change

Peak dose

Augmentation of posterior wall

No change in inf wall

Other territories appropriate augmentation

No ischemia, posterior borderzone viability

Medical therapy, EF improves over time

Pretest probability of CAD influences stress testing results

If low pre-test probability

Potential for high rate of false positive tests

False negative tests will be low

If high pre-test probability

False positive tests will be low

Potential for higher rate of false negative tests

Pre-test probability affecting stress test results

100 pts Pretest likelihood

10 %

CAD +

Sensitivity = 80%

CAD –

 

 

 

10 pts

Specificity = 90 %

90 pts

 

 

 

 

 

 

 

 

False +

 

 

False –

 

True +

 

 

True –

 

 

 

 

 

 

 

9 pts

 

 

2 pts

 

8 pts

 

 

81 pts

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

False Positive rate = 53%

False Negative rate = 2 %

Pre-test probability affecting stress test results

100 pts Pretest likelihood

90 %

CAD +

Sensitivity = 80%

CAD –

 

 

 

90 pts

Specificity = 90 %

10 pts

 

 

 

 

 

 

 

 

False +

 

 

False –

 

True +

 

 

True –

 

 

 

 

 

 

 

1 pts

 

 

18 pts

 

72 pts

 

 

9 pts

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

False Positive rate = 1%

False Negative rate = 66 %