Home Tests & Diagnosis Echo Risks & Limitations

Echo Risks & Limitations

Are there any risks with echocardiography?

Echocardiography testing is very safe and it does not involve radiation. There is a small risk of side effects with the chemicals used in chemical stress tests.6, 7 The contrast dye that is sometimes used may trigger an allergic reaction. It can also damage the kidneys in people with diabetes or previous kidney damage. You should tell your healthcare provider if you have had a reaction to X-ray dye, shellfish, or iodine in the past.

Does a resting or stress echocardiogram have any limitations?

An echo may not give accurate results if you are obese or have been diagnosed with chronic obstructive pulmonary disease, such as emphysema or chronic bronchitis, or if you have surgical incisions. In women who are obese or have large breasts, the image produced by echocardiography may appear fuzzy making it difficult to interpret. These women may have a transesophageal echo—in which the wand (transducer) is passed down the windpipe (or esophagus) to visualize the heart. This type of echo can be uncomfortable; you may be sedated to ease the discomfort. The accuracy of echo testing may be affected by some heart medications (including nitrates, calcium channel blockers, or beta blockers).8 Your doctor will tell you whether you should stop taking any medications before the test. In some cases, you can continue taking your medications and this will be taken into account when it comes to interpreting the test results.

Echocardiography also requires skill and experience; the results may vary depending on how well the test was done.9-11 New developments to improve image quality will make it easier to get the same results no matter who does the test.12

References

1. Sicari R, Pasanisi E, Venneri L, et al. Stress echo results predict mortality: a large-scale multicenter prospective international study. J Am Coll Cardiol. 2003;41:589-595.
2. Dhond MR, Nguyen TT, Sabapathy R, Patrawala RA, Bommer WJ. Dobutamine stress echocardiography in preoperative and long-term postoperative risk assessment of elderly patients. Am J Geriatr Cardiol. 2003;12:107-109, 112.
3. Marwick TH, Case C, Sawada S, et al. Use of stress echocardiography to predict mortality in patients with diabetes and known or suspected coronary artery disease. Diabetes Care. 2002;25:1042-1048.
4. Yao SS, Qureshi E, Sherrid MV, Chaudhry FA. Practical applications in stress echocardiography: risk stratification and prognosis in patients with known or suspected ischemic heart disease. J Am Coll Cardiol. 2003;42:1084-1090.
5. Nasir K, Redberg RF, Budoff MJ, et al. Utility of Stress Testing and Coronary Calcification Measurement for Detection of Coronary Artery Disease in Women. Arch Intern Med. 2004;164:1610-1620.
6. Picano E, Marini C, Pirelli S, et al. Safety of intravenous high-dose dipyridamole echocardiography. The Echo-Persantine International Cooperative Study Group. Am J Cardiol. 1992;70:252-258.
7. Picano E, Mathias W, Jr., Pingitore A, Bigi R, Previtali M. Safety and tolerability of dobutamine-atropine stress echocardiography: a prospective, multicentre study. Echo Dobutamine International Cooperative Study Group. Lancet. 1994;344:1190-1192.
8. Sicari R, Cortigiani L, Bigi R, et al. Prognostic Value of Pharmacological Stress Echocardiography Is Affected by Concomitant Antiischemic Therapy at the Time of Testing. Circulation. 2004;109:2428-2431.
9. Picano E, Lattanzi F, Orlandini A, Marini C, L'Abbate A. Stress echocardiography and the human factor: the importance of being expert. J Am Coll Cardiol. 1991;17:666-669.
10. Hoffmann R, Lethen H, Marwick T, et al. Analysis of interinstitutional observer agreement in interpretation of dobutamine stress echocardiograms. J Am Coll Cardiol. 1996;27:330-336.
11. Hoffmann R, Lethen H, Marwick T, et al. Standardized guidelines for the interpretation of dobutamine echocardiography reduce interinstitutional variance in interpretation. Am J Cardiol. 1998;82:1520-1524.
12. Hoffmann R, Marwick TH, Poldermans D, et al. Refinements in stress echocardiographic techniques improve inter-institutional agreement in interpretation of dobutamine stress echocardiograms. Eur Heart J. 2002;23:821-829.


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