ECHOCARDIOGRAPHY (JM GARDIN, SECTION EDITOR) Stress Echocardiography: What Is New and How Does It Compare with Myocardial Perfusion Imaging and Other Modalities? Marysia S. Tweet 1 & Adelaide M. Arruda-Olson 1 & Nandan S. Anavekar 1 & Patricia A. Pellikka 1 # Springer Science+Business Media New York 2015 Abstract Cardiovascular disease is a leading cause of mor- bidity and mortality, and noninvasive strategies to diagnose and risk stratify patients remain paramount in the evaluative process. Stress echocardiography is a well-established, versa- tile, real-time imaging modality with advantages including lack of radiation exposure, portability, and affordability. Inno- vative techniques in stress echocardiography include myocar- dial contrast echocardiography, deformation imaging, three- dimensional (3D) echocardiography, and assessment of coro- nary flow reserve. Myocardial perfusion imaging with single- photon emission computed tomography (SPECT) or positron emission tomography (PET) are imaging alternatives, and stress cardiac magnetic resonance imaging and coronary com- puted tomography (CT) angiography, including CT perfusion imaging, are emerging as newer approaches. This review will discuss recent and upcoming developments in the field of stress testing, with an emphasis on stress echocardiography while highlighting comparisons with other modalities. Keywords Stress testing . Exercise echocardiography . Dobutamine echocardiography . Myocardial perfusion imaging . Single-photon emission computed tomography . Positron emission tomography . Cardiac magnetic resonance imaging . Coronary computed tomography angiography Introduction Cardiovascular disease, particularly coronary artery disease (CAD), remains a leading cause of morbidity and mortality, and noninvasive techniques to diagnose and risk stratify pa- tients with suspected or known cardiovascular disease are a mainstay [1]. Stress imaging can assess for cardiac abnormal- ities in a patient with symptoms or signs suggestive of CAD, detect progression in those with established disease, identify coronary territories contributing to ischemia, and characterize non-CAD cardiovascular diseases [2•]. Stress echocardiogra- phy remains an important and adaptable tool; recent advance- ments and evidence have expanded its applications. Nuclear perfusion stress testing, cardiac magnetic resonance stress im- aging, and cardiac computed tomography (CT) are alterna- tives for noninvasive assessment. Each strategy has its strengths for particular patient subtypes and clinical questions (Table 1); it is essential for health care providers to strategi- cally select the most appropriate stress test tailored for the patient [3••, 4, 5]. Recent concern about radiation exposure [6••] has increased interest in stress echocardiography com- pared with nuclear perfusion imaging and CT. Stress Echocardiography Stress echocardiography is an established technique that en- compasses two-dimensional (2D)-echo imaging of wall This article is part of the Topical Collection on Echocardiography * Patricia A. Pellikka pellikka.patricia@mayo.edu Marysia S. Tweet tweet.marysia@mayo.edu Adelaide M. Arruda-Olson arruda-olson.adelaide@mayo.edu Nandan S. Anavekar anavekar.nandan@mayo.edu 1 Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA Curr Cardiol Rep (2015) 17:43 DOI 10.1007/s11886-015-0600-1