Stress echocardiography: a historical perspective

Stress echocardiography is a popular cardiac imaging technique that provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging. Similar accuracy, however, should not be synonymous with being “clinically interchangeable.” Because of economic cost, environmental impact, and individual biohazard exposure, a nuclear examination should be performed only when it cannot be replaced by other techniques that do not employ ionizing radiation. Nuclear medical imaging procedures, of which cardiological procedures are an important part, account for 4% of the annual effective radiation dose received by the average person in the United States. At the individual level, the radiological exposure of a single nuclear cardiology procedure conveys a low, but measurable, risk of fatal cancer, which varies from 1 in 1000 to 1 in 10,000, depending on the type of examination (higher for thallium scans; lower for technetium 99m methoxyisobutylisonitrile scans). Because the information provided by stress echocardiography and stress radionuclide perfusion imaging are similar, the choice of test should be made in the context of the environmental, biological, and economic effects of that choice.