Use of echocardiography for patient management in chronic ischemic heart disease.

Abstract

Myocardial ischemia causes regional myocardial contractile and relaxation abnormalities. The extent of ischemia is determined by the distribution and severity of coronary artery stenoses. In coronary heart disease, two powerful predictors of prognosis are the coronary anatomy and ventricular function. Management in coronary heart disease is directed by accurate diagnosis and individualized objectives. Echocardiography at rest and exercise, combined with Doppler and color flow imaging, are properly applied to the differential diagnosis of common clinical syndromes in ischemic heart disease, the identification of the proximal coronary arteries, and the effects of ischemia and prior infarction. Subsequent use of coronary arteriography partially depends on the philosophy regarding the applicability of coronary surgery or angioplasty in an individual patient. Prediction of multivessel, left main, or proximal left anterior descending coronary artery disease by extensive wall motion abnormalities or an abnormal left ventricular ejection fraction may direct the clinician to coronary arteriography to select among coronary surgery, angioplasty, or medical management.