Stress echocardiography and invasive coronary angiography in the current diagnostic algorithm for coronary artery disease (A case of Vladivostok Clinical Hospital No. 1)

Stress echocardiography (Stress-ECHOCG) is a noninvasive method for diagnosing coronary artery disease (CAD) that allows for the detection of transient abnormalities in local contractility during exercise. Objective: To evaluate the role of stress echocardiography in diagnosing stable coronary artery disease (CAD) compared to invasive coronary angiography (ICA). Materials and methods. Stress-ECHOCG was performed on 34 patients with suspected CAD at the Functional Diagnostics Department of Vladivostok Clinical Hospital No 1. The Stress-ECHOCG results were then compared with those of ICA. Results. The sensitivity of stress echocardiography was 96.8%, and the positive predictive value was 90.9%. A positive stress echocardiogram was associated with stenoses in the basins of the anterior descending artery (r = 0.91), the circumflex artery (r = 0.89), and the right coronary artery (r = 0.91). Conclusion. Stress echocardiography plays a crucial role in the diagnostic algorithm for coronary artery disease, offering high accuracy and safety. Using stress echocardiography helps optimize patient selection for invasive testing and reduces the number of unnecessary coronary angiograms.

1. Kotovskaya YuV, Tkacheva ON, Runikhina NK, Luzina AV. Physical activity as preventive measure against cardiovascular disease in elderly patients. Doctor.Ru. 2019;(2):19–22. (In Russ.). doi: 10.31550/1727-2378-2019-157-2-19-22

2. Barbarash OL, Karpov YuA, Panov AV, Akchurin RS, Alekyan BG, Alekhin MN et al. Clinical practice guidelines for Stable coronary artery disease 2024. Russian Journal of Cardiology. 2024;29(9):6110. (In Russ.). doi: 10.15829/1560-4071-2024-6110

3. Sicari R, Cortigiani L. The clinical use of stress echocardiography in ischemic heart disease. Cardiovasc Ultrasound. 2017;15(1):7. doi: 10.1186/s12947-017-0099-2

4. Matskeplishvili ST, Saidova MA, Mironenko MYu, Safarova AF, Pavlyukova EN, Boshchenko AA et al. Standard transthoracic echocardiography. Guidelines 2024. Russian Journal of Cardiology. 2025;30(2):6271 (In Russ.). doi: 10.15829/1560-4071-2025-6271

5. Sicari R, Nihoyannopoulos P, Evangelista A, Kasprzak J, Lancellotti P, Poldermans D et al. European Association of Echocardiography. Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur J Echocardiogr. 2008;9(4):415–437. doi: 10.1093/ejechocard/jen175

6. Yarmedova SF, Yavelov IS, Drapkina OM. Myocardial ischemia as a cause of paroxysmal dyspnea in patients with stable coronary artery disease. Cardiovascular Therapy and Prevention. 2024;23(12):4267. (In Russ.). doi: 10.15829/1728-8800-2024-4267

7. Dydyshko VT, Naumkina PI, Grigoriev SG, Glebova SA, Borisova EV, Barsukov AV. Predictors of low tolerance to physical activity in young and middle-age men. Physiсal and Rehabilitation Medicine. 2024;6(2):12–26. (In Russ.). doi: 10.26211/2658-4522-2024-6-2-12-26

8. Surnina OV, Ponomareva IA, Zaitsev DS, Smetanin MYu, Sosnovskikh MS, Lamonova IE et al. Stress echocardiography as a tool for diagnosing atherosclerotic changes in the coronary arteries in patients with stable coronary heart disease. Ateroscleroz. 2025;21(3):289–295. (In Russ.). doi: 10.52727/2078-256X-2025-21-3-289-295

9. Mehta P, McDonald S, Hirani R, Good D, Diercks D. Major adverse cardiac events after emergency department evaluation of chest pain patients with advanced testing: Systematic review and meta-analysis. Acad Emerg Med. 2022;29(6):748–764. doi: 10.1111/acem.14407

10. Mikheev NN. The role of combined methods of stress-echocardiography in atherosclerotic obliteration of coronary arteries. Kazan Medical Journal. 2006;87(2):86–89. (In Russ.).

11. Gaibazzi N, Ciampi Q, Cortigiani L, Wierzbowska-Drabik K, Zagatina A, Djordjevic-Dikic A et al. Stress Echo 2030 Study Group. Multiple phenotypes of chronic coronary syndromes identified by ABCDE Stress Echocardiography. J Am Soc Echocardiogr. 2024;37(5):477–485. doi: 10.1016/j.echo.2023.12.003

12. Ciampi Q, Zagatina A, Cortigiani L, Gaibazzi N, Borguezan Daros C, Zhuravskaya N et al. Functional, anatomical, and prognostic correlates of coronary flow velocity reserve during stress echocardiography. J Am Coll Cardiol. 2019;74(18):2278–2291. doi: 10.1016/j.jacc.2019.08.1046

13. Kozlov SG, Chernova OV, Shitov VN, Veselova TN, Saidova MA, Ternovoy SK. Stress echocardiography vs coronary computed tomography angiography for the detection of obstructive coronary artery disease in patients aged >70 years with suspected stable coronary artery disease. Cardiovascular Therapy and Prevention. 2020;19(5):2374. (In Russ.). doi: 10.15829/1728-8800-2020-2374

14. Sumin AN, Starovoytova AV, Shcheglova AV, Gorbunova EV. Contemporary algorithms for diagnosing obstructive coronary artery disease in real clinical practice. Acta Biomedica Scientifica. 2024;9(3):111–20. (In Russ.). doi: 10.29413/ABS.2024-9.3.11

15. Bombardini T, Zagatina A, Ciampi Q, Cortigiani L, D'Andrea A, Borguezan Daros C et al. Feasibility and value of two-dimensional volumetric stress echocardiography. Minerva Cardiol Angiol. 2022;70(2):148–159. doi: 10.23736/S2724-5683.20.05304-9