January 2020

Since the 2007 publication of the ASE guidelines for stress echocardiography, new information has become available about the methodology of stress echocardiography, including test protocols, standards for interpretation (including quantitative methods of assessment and application of strain rate imaging), appropriateness of testing, comparison with other modalities for assessing ischemic heart disease (IHD), safety of stress echocardiography, application of the technique in children and special populations, prognostic value, and role of ultrasound enhancing agents (UEA) and perfusion imaging. This updated document includes this new information and summarizes current practice recommendations and training requirements. Additionally, a class of recommendation and level of evidence for diagnostic strategies using stress echocardiography have been added. These recommendations are made according to the 2015 American College of Cardiology/American Heart Association clinical practice guidelines. Specific recommendations and main points are identified in bold. Although stress echocardiography may be applied in the assessment of many diverse cardiac conditions, the current document describes its applications in IHD. Supplementary online content of this document includes 32 illustrative video clips and their legends (see Videos 1-32, available online at www.onlinejase.com) for readers interested in visual examples of normal, ischemic, contrast, perfusion, and viability stress echocardiograms, as well as quantitative methods of analysis.