Nowadays it is generally observed in clinical practice that lower risk patients with atypical chest pain symptoms are more often referred to exercise ECG. If we consider the bayesian approach in such patients, there is an increase in false positive results with consequent limited ability of this noninvasive test to add incremental value for the identification of obstructive CAD. A negative peak exercise stress echo- ESE has a long-term favourable prognostic value. Recent studies reported that patients with negative ESE had excellent long-term outcomes (annualized event rate of 1%), regardless of ‘ischaemic’stress electrocardiographic changes results over a median 95-month follow-up period. Therefore, in an outpatient population evaluated for chest pain after inconclusive first-line work-up including clinical evaluation and

exercise stress test, a negative peak ESE confers an excellent prognosis regardless of the nature of concomitant stress ECG abnormalities and may be considered a

useful ‘gatekeeper cardiac imaging test’ in daily clinical practice.

yes, definitely stress echo (DST) will help in diagnosing sub clinical CAD with normal resting ECG

OK Dr. Giuseppe. I agree with you and I think SE has an important contribuition in the evaluation of CAD

Stress echo has important role in diagnosing and following up patients with CAD  but unfortunately false positive and false negative cases become a cause of concern sometimes to most experienced person too.

The difference that I find between stress echo and the other studies like stress thallium and MRI is that it is real time and we can see the actual difference in contractility which to a surgeon is more reassuring. The wall thickness and the corresponding disease segments in wall contractility corelated by angiography give other important clues. The traditional "end of the bed " test is ofcourse the clincher in actually accepting a patient for CABG.