The Contemporary Role of Stress Echocardiography in the Diagnosis and Management of Chronic Coronary Syndrome: From Physiology to Clinical Strategy
Received: 2026-07-15
Published: 2026-06-29
Abstract
Chronic coronary syndrome (CCS) remains one of the leading causes of mortality and disability worldwide, particularly in Central Asian countries and the Republic of Uzbekistan. This review presents a contemporary perspective on the role of stress echocardiography in the diagnosis, risk stratification, and determination of treatment strategies in patients with CCS. The evolution of the CCS concept, the key pathophysiological mechanisms of ischemia (epicardial stenosis, coronary microvascular dysfunction, and vasospasm), and ANOCA/INOCA conditions are discussed. The diagnostic and prognostic value of stress echocardiography is compared with that of other modalities, including exercise electrocardiography, SPECT, PET, and stress cardiac MRI. Particular attention is paid to exercise stress echocardiography performed using a semi-supine bicycle ergometer, the advantages of imaging at peak exercise, and contemporary quantitative techniques, including strain imaging and coronary flow reserve assessment. An analysis of landmark trials (COURAGE, FAME, and ISCHEMIA) and the 2024 ESC Guidelines showed that stress echocardiography serves as an effective gatekeeper for invasive coronary angiography and plays an important role in decision-making regarding endovascular revascularization. The cost-effectiveness, safety, and operator dependence of the method are also discussed. Conclusion. Stress echocardiography is an accessible, safe, and highly effective functional diagnostic method with an optimal cost-effectiveness profile. In the Republic of Uzbekistan and Central Asia, the widespread implementation of stress echocardiography, particularly using a semi-supine bicycle ergometer, may substantially optimize diagnostic algorithms and improve treatment outcomes in patients with chronic coronary syndrome.
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Copyright (c) 2026 Х.Г. Фозилов, Ф.М. Бекметова, Б.Б. Рузиев, Ш.А. Оринбаев (Автор)
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