From the Guidelines
The stress echocardiogram results are completely normal, indicating no evidence of coronary artery disease or cardiac dysfunction, and suggest a low risk for future cardiovascular events, with an annual risk for cardiac death or MI likely less than 1% 1. The test shows normal heart rhythm (sinus rhythm) with a normal ECG pattern both at rest and during stress. There were no concerning ST or T wave changes that would suggest ischemia (inadequate blood flow to the heart muscle). No abnormal heart rhythms (arrhythmias) occurred during the test. The left ventricle, which is the main pumping chamber of the heart, demonstrated normal function at rest and appropriately improved function during exercise, which is the expected healthy response. All segments of the heart wall moved normally both at rest and with stress, with proper augmentation (increased contractility) during exercise. This indicates that blood flow to all regions of the heart muscle is adequate, even during increased demand. Some key points to consider based on the evidence include:
- A normal stress echocardiogram is associated with a low risk of future cardiovascular events, as noted in the 2024 ESC guidelines for the management of chronic coronary syndromes 1.
- The annual risk for cardiac death or MI is likely less than 1% for individuals with normal stress echocardiogram results, as supported by studies such as the one published in the European Heart Journal in 2024 1.
- Regular follow-up with a healthcare provider for routine cardiovascular risk assessment is still recommended, even with normal stress echocardiogram results, to monitor for any changes in cardiovascular risk factors.
- The use of stress echocardiography for risk stratification is supported by guidelines, including those from the American College of Cardiology Foundation and the European Society of Cardiology 1.
From the Research
Stress Echo Results
The stress echo results show:
- Normal sinus rhythm - normal ECG
- No abnormal ST/T wave changes with stress
- No arrhythmias were observed during the examination
- Overall global left ventricular systolic function improved post-stress
- No regional wall motion abnormalities noted at rest
- Normal left ventricular systolic function with no regional wall motion abnormalities noted at rest
- No regional wall motion abnormalities noted post-stress
- Normal augmentation of all wall segments without evidence of ischemia with stress
Implications of Stress Echo Results
Based on the studies, the implications of these results are:
- A normal stress echocardiogram is associated with a low risk of cardiac events, as shown in a study of 661 patients with atypical chest pain 2
- Stress echocardiography is an established technique for assessing the extent and severity of coronary artery disease, with excellent accuracy for detecting myocardial ischemia 3
- The presence of normal stress echocardiography results, even with abnormal exercise electrocardiography, is associated with a lower risk of adverse cardiac events compared to those with abnormal stress echocardiography results 4
- Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging, but at a substantially lower cost and without environmental impact or biohazards 5
Clinical Applications of Stress Echocardiography
The clinical applications of stress echocardiography include:
- Diagnostic evaluation of patients with ischemic and non-ischemic cardiac diseases 6
- Assessment of extent and severity of coronary artery disease 3
- Detection of myocardial ischemia 3, 5
- Prognostic evaluation of patients with atypical chest pain 2
- Guidance of medical management and potential intensification of treatment for patients with abnormal exercise electrocardiography and normal stress echocardiography results 4