Introduction: Doppler myocardial imaging provides sensitive indicators for diagnosing subendocardial dysfunction, but their specificity is low (1). We wanted to establish whether exercise gas exchange measurement might improve differing myocardial ischemia from fibrosis.

Case report: In the case of 79-year-old woman with the history of the myocardial infarction and the left anterior descending artery stenting 7 years ago, quantitative exercise stress echocardiography was done due to emerging atypical chest pain. In mid anteroseptal segment, there was significant decrease in myocardial systolic velocity /delta Vs -73,83/, in deformation velocity /delta SR-88,96/ and deformation /delta S-62,21/. Deformation velocity was decreased in mid inferior segment as well /delta SR-20,23/. Measurement of exercise gas exchange showed slight decrease of oxygen consumption parameters /pVO₂ 76%, ATVO₂ 30%, O₂ pulse 67% of the predicted values and dVO₂/dWR 8.80 ml/min/W/ but without “ischemic threshold”.

Conclusion: Measurement of exercise gas exchange during quantitative stress echocardiography might help differentiating myocardial ischemia from fibrosis.