ARDMS Echo Advanced Imaging and Stress Echocardiography 1 — Questions and Answers
Question 1: What is the primary goal of dobutamine stress echocardiography (DSE) in detecting coronary artery disease?
- Provoke ischemia-induced regional wall motion abnormalities at peak stress (Correct answer)
- Measure coronary flow reserve directly
- Assess diastolic function at rest only
- Quantify valve gradients at peak heart rate
Correct answer: Provoke ischemia-induced regional wall motion abnormalities at peak stress
DSE uses dobutamine to increase heart rate and myocardial oxygen demand; ischemic segments develop new or worsening regional wall motion abnormalities at peak stress.
Question 2: Which finding during dobutamine stress echocardiography indicates myocardial viability in a dysfunctional segment?
- Biphasic response: improved function at low dose, then worsening at peak dose (Correct answer)
- No change in wall motion at any dose
- Worsening wall motion at all doses
- Hyperkinesis at all doses
Correct answer: Biphasic response: improved function at low dose, then worsening at peak dose
A biphasic response (improvement at low-dose dobutamine followed by deterioration at peak dose) indicates hibernating myocardium — viable but ischemic tissue that can recover after revascularization.
Question 3: In transesophageal echocardiography (TEE), which probe position best evaluates the left atrial appendage (LAA) for thrombus?
- Mid-esophageal position at 0° and 90° multiplane angles (Correct answer)
- Deep transgastric view
- High esophageal position at 0°
- Transgastric short-axis at 0°
Correct answer: Mid-esophageal position at 0° and 90° multiplane angles
The mid-esophageal position with multiplane imaging at 0° and 90° (or using biplane mode) provides the best visualization of the LAA for thrombus detection before cardioversion.
Question 4: What is the most common indication for intraoperative TEE during cardiac surgery?
- Assessment of ventricular function and valve repair/replacement results (Correct answer)
- Detection of coronary artery disease
- Measurement of LVEF only
- Screening for pericardial disease
Correct answer: Assessment of ventricular function and valve repair/replacement results
Intraoperative TEE is used to evaluate baseline cardiac function, guide surgical repair, and assess immediate post-repair results including valve function and ventricular filling.
Question 5: Which echocardiographic contrast agent is used to improve endocardial border delineation during stress echocardiography?
- Perflutren lipid microspheres (e.g., Definity or Optison) (Correct answer)
- Agitated saline
- Iodinated contrast
- Gadolinium
Correct answer: Perflutren lipid microspheres (e.g., Definity or Optison)
Perflutren-based ultrasound contrast agents (Definity, Optison) are FDA-approved for LV opacification to improve endocardial border definition when ≥2 segments are not well visualized.
Question 6: What is the target heart rate during exercise stress echocardiography for adequate diagnostic yield?
- At least 85% of maximum predicted heart rate (220 − age) (Correct answer)
- 100% of maximum heart rate
- 70% of maximum heart rate
- A heart rate of 140 bpm regardless of age
Correct answer: At least 85% of maximum predicted heart rate (220 − age)
Achieving ≥85% of maximum predicted heart rate (220 − age) is required for adequate diagnostic sensitivity in exercise stress echocardiography for coronary artery disease.
ARDMS Echo Advanced Imaging and Stress Echocardiography 1
What is the primary goal of dobutamine stress echocardiography (DSE) in detecting coronary artery disease?