ARDMS Echo Advanced Imaging and Stress Echocardiography 2 — Questions and Answers
Question 1: Which new wall motion abnormality pattern during stress echocardiography is consistent with left anterior descending artery (LAD) ischemia?
- Anterior and apical hypokinesis/akinesis (Correct answer)
- Inferior and posterior wall abnormality
- Lateral wall hypokinesis only
- Basal inferior and lateral wall abnormality
Correct answer: Anterior and apical hypokinesis/akinesis
LAD territory ischemia typically manifests as anterior wall and apical regional wall motion abnormalities due to the LAD supplying the anterior LV wall and apex.
Question 2: In 3D echocardiography, what is the primary advantage over 2D methods for measuring LV volumes?
- Avoids geometric assumptions and foreshortening, improving accuracy (Correct answer)
- Better image resolution in all patients
- Faster acquisition time in all patients
- No need for ECG gating
Correct answer: Avoids geometric assumptions and foreshortening, improving accuracy
3D echocardiography directly acquires the full LV volume without relying on geometric assumptions (e.g., ellipsoid model) and avoids the apical foreshortening inherent in 2D imaging.
Question 3: What is speckle tracking echocardiography (STE) used to measure?
- Myocardial strain and strain rate to detect subclinical dysfunction (Correct answer)
- Blood flow velocity in the LVOT
- Pericardial thickness
- Valve leaflet morphology
Correct answer: Myocardial strain and strain rate to detect subclinical dysfunction
STE tracks natural acoustic speckles frame-to-frame to calculate myocardial deformation (strain) in longitudinal, circumferential, and radial directions, detecting subtle dysfunction before EF drops.
Question 4: What global longitudinal strain (GLS) value suggests subclinical LV dysfunction even with preserved EF?
- GLS more negative than −16% is normal; values between −16% and −20% suggest subtle dysfunction; worse than −20% is normal
- GLS less negative than −16% (e.g., −14%) suggests subclinical dysfunction (Correct answer)
- GLS of −5% is normal
- Any GLS value is within normal range if EF > 55%
Correct answer: GLS less negative than −16% (e.g., −14%) suggests subclinical dysfunction
Normal GLS is typically more negative than −20%; GLS less negative than −16% (e.g., −14%, −12%) suggests subclinical myocardial dysfunction even when EF appears preserved.
Question 5: Which TEE view is best for evaluating the thoracic aorta for dissection?
- High esophageal descending aorta view combined with mid-esophageal aortic views (Correct answer)
- Transgastric short-axis view
- Deep transgastric apical view
- Mid-esophageal four-chamber view
Correct answer: High esophageal descending aorta view combined with mid-esophageal aortic views
The descending aorta is evaluated with the probe in the esophagus and withdrawn from the stomach to the arch; mid-esophageal views assess the ascending aorta and arch for dissection flap.
Question 6: What is a contraindication to dobutamine stress echocardiography?
- Significant cardiac arrhythmia or severe uncontrolled hypertension (Correct answer)
- Mild stable angina
- History of hypertension well-controlled on medication
- Prior CABG with preserved EF
Correct answer: Significant cardiac arrhythmia or severe uncontrolled hypertension
DSE is contraindicated in patients with significant arrhythmias, severe hypertension (>200/110 mmHg), recent MI, severe aortic stenosis, or aortic dissection due to risk of hemodynamic compromise.
ARDMS Echo Advanced Imaging and Stress Echocardiography 2
Which new wall motion abnormality pattern during stress echocardiography is consistent with left anterior descending artery (LAD) ischemia?