[Diagnosis of coronary artery disease - part 3 : stress echocardiography and cardiac magnetic resonance imaging]

The diagnostic principle of stress echocardiography and cardiac magnetic resonance imaging (CMR) for the diagnosis of coronary artery disease is based on the visualisation of ischaemia-induced wall motion abnormalities. From a logistic point of view, stress echocardiography is the easiest test given that it can be performed at bedside. Both stress echocardiography and stress CMR also permit direct visualisation of myocardial perfusion at rest and during pharmacological stress (typically adenosine) using contrast administration (microbubbles for stress echocardiography, gadolinium for stress CMR). These novel methods for the visualisation of myocardial perfusion seem to provide information similar to that obtained using myocardial perfusion imaging but these techniques (particularly myocardial perfusion echocardiography) are not broadly established in daily practice yet. Similar to other non-invasive tests stress echocardiography and stress CMR have the highest diagnostic yield in patients with intermediate probability of significant coronary artery disease.