Do you stratify patients for exercise stress echo (fitness, obesity...)?
Yes, we sometimes do, in these cases pharmacologic test might be easier to do, patient and yourself would.Both struggle having/doing the test, but one would miss extra information on exercise capacity.
Do you also stop other negative chronotropic drugs like diltiazem, verapamil, ivabradine?
Yes, we do, you may carry on with them for dipyridamol stress echo, but it does impair the accuracy of the test. For DSE you must stop them 48hours prior the test.
How easy is it to give contrast injection at peak exercise?! Is there a best place to put the IV line?
Contrast on treadmil is given approx. 20s prior stopping exercise, on bike it is not an issue. Antecubital large (pink) vienflow should be default if feasible.
Is it possible to use dobutamin and supine bike together?
Yes, in some labs they do DSE and low exrcise workload which is having similar effect as handgrip.
Has STICH changed practice in regards of viability assessment prior the (surgical) revascularisation?
Not in our hospital.
Can you briefly summarize the rules for discontinuing / not discontinuing beta-blocker therapy before the stress test? There are many interpretations. Thank you
It is recommended to stop B blocker at least 48 hours prior the test. I ussually wean the patient off it gradually over four days, and sometimes replace with another antihypertensive medication if B blocker is prescribed for this indication.
What are the options of SE in children? Thanks.
No experience with children but dynamic stress echo would be preferred method. Inded there are reports ofusing stress echo in congenital heart disease.
Is there any stress echo protocol modification for exercise with upright cycle ergometer? Thank you.
I think that doing this would be very technically challenging due to the position of the patient/heart, otherwise the protocol would remain the same.
Is there any difference in clinical use of different contrast agents? What's your experience with Lumitiy as opposed to Sonovue?
Each contrast require slightly different ultrasound setting to obtain the best possible images and is storred and handed differently. Also bear in mind that in many countries only one transpulmonary contrast is registered. Cannot answer on Luminity, I use Sonovue only.
How do you use contrast for enhancing Doppler signals? When I try it always produced lots of loud noise!
The trick is to lower the gain, give very small dose and let the contrast wean off the circulation before you acquire PW/CW doppler images.
How about TOE and contrast? Do someone has expirience?
With GE TOE one can use low MI setting, but Philips TOE probe so far does not have this functionality. You might try to lower the MI by lowering the power but it is usually not enough. In clinical practice it can be very uselful to differentiate dense smoke and thrombus.
Is there any difference in clinical use of different contrast agents?
Each contrast require slightly different ultrasound setting to obtain the best images.
What's your experience with Lumitiy as opposed to Sonovue?
I have no experience with Luminity, sorry.
How about TOE and contrast? Do someone has expirience?
To my knowledge GE is having TOE probe with low MI preset. Can be very useful to rule out thrombus, differentiating it from „sludge“ or heavy spont. echocontrast. In other machines you can try to lower overal output power, but it does not work very well.
Is it possible to do contrast perfusion study without low MI company seetting on our machine. If we have just LVO setting?
No, you must have low (ie. very low around 0,10) MI