Wiener klinische Wochenschrift

, Volume 127, Issue 13–14, pp 514–520 | Cite as

Stress-echocardiography is underused in clinical practice: a nationwide survey in Austria

  • David Weidenauer
  • Philipp Bartko
  • Heidemarie Zach
  • Manfred Zehetgruber
  • Hans Domanovits
  • Senta Graf
  • Gerald Mundigler
original article
First Online:
Received:
Accepted:

Summary

Background

The wide area of application, including coronary artery disease, valvular heart disease, or pulmonary hypertension makes stress echocardiography (SE) a powerful, cost-effective imaging modality in cardiology. The role of this technique in clinical practice in Austria is unknown.

Methods

A nationwide survey included all departments for cardiology and/or internal medicine in the years 2008 and 2013. By electronic questionnaire demographics, indication for the test, the numbers of examined cases per year, operators, and various applied techniques of SE were interrogated and completed by telephone interviews.

Results

Data could be obtained from all 117 departments. In the year 2007 in 58 (50 %) and in 2012 57 (49 %) departments SE was available in Austrian hospitals. More than 100 SEs per year were performed by only four (7 %) units in the year 2007 and by five (8 %) in 2012. Physical exercise, dobutamine, and dipyridamole SE were available in 27 (46 %), 52 (90 %), and six (10 %) units in 2007, and in 15 (27 %), 52 (91 %), and five (9 %) units in 2012, respectively. In 2007 41 (71 %) and in 2012 26 (46 %) echo-labs administered contrast agents during SE. Transesophageal SE and 3D-echo was performed in one (2 %) and three (5 %) units in 2007, and in six (10 %) and four (7 %) echo-labs in 2012.

Conclusions

This representative survey demonstrates the underuse of SE in clinical practice in Austria. Even in established application fields performance is low, examination frequencies as recommended by the cardiology societies are fulfilled only by a minority of institutions.

Keywords

Stress echocardiography Coronary artery disease Valvular heart disease Quality standards Echo lab 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

There were no sources of support or funding.

Conflict of interest

All authors declare that there are no actual or potential conflicts of interest related to this article.

References

  1. 1.
    Bedetti G, Pasanisi EM, Pizzi C, et al. Economic analysis including long-term risks and costs of alternative diagnostic strategies to evaluate patients with chest pain. Cardiovasc Ultrasound. 2008;6:21.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Jeetley P, Burden L, Stoykova B, et al. Clinical and economic impact of stress echocardiography compared with exercise electrocardiography in patients with suspected acute coronary syndrome but negative troponin: a prospective randomized controlled study. Eur Heart J. 2007;28:204–11.PubMedCrossRefGoogle Scholar
  3. 3.
    Varga A, Garcia MA, Picano E, et al. Safety of stress echocardiography (from the International Stress Echo Complication Registry). Am J Cardiol. 2006;98:541–3.PubMedCrossRefGoogle Scholar
  4. 4.
    Sicari R, Nihoyannopoulos P, Evangelista A, et al. Stress echocardiography expert consensus statement–executive summary: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur Heart J. 2009;30:278–89.PubMedCrossRefGoogle Scholar
  5. 5.
    Cullen MW, Pellikka PA. Recent advances in stress echocardiography. Curr Opin Cardiol. 2011;26:379–84.PubMedCrossRefGoogle Scholar
  6. 6.
    Ingul CB, Stoylen A, Slordahl SA, et al. Automated analysis of myocardial deformation at dobutamine stress echocardiography: an angiographic validation. J Am Coll Cardiol. 2007;49:1651–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Voigt JU, Exner B, Schmiedehausen K, et al. Strain-rate imaging during dobutamine stress echocardiography provides objective evidence of inducible ischemia. Circulation. 2003;107:2120–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Bartko PE, Heinze G, Graf S, et al. Two-dimensional strain for the assessment of left ventricular function in low flow-low gradient aortic stenosis, relationship to hemodynamics, and outcome: a substudy of the multicenter TOPAS study. Circ Cardiovasc Imaging. 2013;6:268–76.PubMedCrossRefGoogle Scholar
  9. 9.
    Dahou A, Bartko PE, Capoulade R, et al. Usefulness of global left ventricular longitudinal strain for risk stratification in low ejection fraction, low-gradient aortic stenosis: results from the multicenter true or pseudo-severe aortic stenosis study. Circ Cardiovasc imaging. 2015;8:e002117.PubMedCrossRefGoogle Scholar
  10. 10.
    Picano E, Pellikka PA. Stress echo applications beyond coronary artery disease. Eur Heart J. 2014;35:1033–40.PubMedCrossRefGoogle Scholar
  11. 11.
    Pellikka PA, Nagueh SF, Elhendy AA, et al. American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr. 2007;20:1021–41.PubMedCrossRefGoogle Scholar
  12. 12.
    Popescu BA, Stefanidis A, Nihoyannopoulos P, et al. Updated standards and processes for accreditation of echocardiographic laboratories from the European Association of Cardiovascular Imaging: an executive summary. Eur Heart J Cardiovasc Imaging. 2014;15:1188–93.PubMedCrossRefGoogle Scholar
  13. 13.
    Gershlick AH, de Belder M, Chambers J, et al. Role of non-invasive imaging in the management of coronary artery disease: an assessment of likely change over the next 10 years. A report from the British Cardiovascular Society working group. Heart. 2007;93:423–31.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Bhattacharyya S, Chehab O, Khattar R, et al. Stress echocardiography in clinical practice: a United Kingdom National Health Service Survey on behalf of the British Society of Echocardiography. Eur Heart J Cardiovasc Imaging. 2014;15:158–63.PubMedCrossRefGoogle Scholar
  15. 15.
    Aumiller J. Neue Herzstatistik: Herzbericht 2005. Herz. 2006;31:811–3.Google Scholar
  16. 16.
    Fox K, Garcia MA, Ardissino D, et al. Guidelines on the management of stable angina pectoris: executive summary: the task force on the management of stable angina pectoris of the European Society of Cardiology. Eur Heart J. 2006;27:1341–81.PubMedCrossRefGoogle Scholar
  17. 17.
    Hamm CW, Bassand JP, Agewall S, et al. ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the task force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:2999–3054.PubMedCrossRefGoogle Scholar
  18. 18.
    Becher H, Chambers J, Fox K, et al. BSE procedure guidelines for the clinical application of stress echocardiography, recommendations for performance and interpretation of stress echocardiography: a report of the British Society of Echocardiography Policy Committee. Heart. 2004;90(Suppl 6):vi23–30.PubMedCentralPubMedGoogle Scholar
  19. 19.
    Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation. 1999;99:2829–48.PubMedCrossRefGoogle Scholar
  20. 20.
    Lancellotti P, Magne J Stress echocardiography in regurgitant valve disease. Circ Cardiovasc Imaging. 2013;6:840–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Bhattacharyya S, Khattar R, Chahal N, et al. Dynamic assessment of stenotic valvular heart disease by stress echocardiography. Circ Cardiovasc Imaging. 2013;6:583–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Galie N, Hoeper MM, Humbert M, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J. 2009;30:2493–537.PubMedCrossRefGoogle Scholar
  23. 23.
    Ishii K, Suyama T, Imai M, et al. Abnormal regional left ventricular systolic and diastolic function in patients with coronary artery disease undergoing percutaneous coronary intervention: clinical significance of post-ischemic diastolic stunning. J Am Coll Cardiol. 2009;54:1589–97.PubMedCrossRefGoogle Scholar
  24. 24.
    Lucats L, Ghaleh B, Monnet X, et al. Conversion of post-systolic wall thickening into ejectional thickening by selective heart rate reduction during myocardial stunning. Eur Heart J. 2007;28:872–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Bijnens B, Claus P, Weidemann F, et al. Investigating cardiac function using motion and deformation analysis in the setting of coronary artery disease. Circulation. 2007;116:2453–64.PubMedCrossRefGoogle Scholar
  26. 26.
    Weidemann F, Herrmann S, Stork S, et al. Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis. Circulation. 2009;120:577–84.PubMedCrossRefGoogle Scholar
  27. 27.
    Elhendy A, O’Leary EL, Xie F, et al. Comparative accuracy of real-time myocardial contrast perfusion imaging and wall motion analysis during dobutamine stress echocardiography for the diagnosis of coronary artery disease. J Am Coll Cardiol. 2004;44:2185–91.PubMedCrossRefGoogle Scholar
  28. 28.
    Tsutsui JM, Elhendy A, Anderson JR, et al. Prognostic value of dobutamine stress myocardial contrast perfusion echocardiography. Circulation. 2005;112:1444–50.PubMedCrossRefGoogle Scholar
  29. 29.
    Senior R, Moreo A, Gaibazzi N, et al. Comparison of sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography with gated single-photon emission computed tomography for detection of significant coronary artery disease: a large European multicenter study. J Am Coll Cardiol. 2013;62:1353–61.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2015

Authors and Affiliations

  • David Weidenauer
    • 1
  • Philipp Bartko
    • 1
  • Heidemarie Zach
    • 1
  • Manfred Zehetgruber
    • 1
  • Hans Domanovits
    • 2
  • Senta Graf
    • 1
  • Gerald Mundigler
    • 1
  1. 1.Division of Cardiology, Department of Internal Medicine IIMedical University ViennaViennaAustria
  2. 2.Department of Emergency MedicineMedical University ViennaViennaAustria

Personalised recommendations