Stress echocardiography in clinical practice: a United Kingdom National Health Service Survey on behalf of the British Society of Echocardiography.

AIMS: Stress echocardiography (SE) is one of the leading modalities for the assessment of coronary artery disease and dynamic valvular heart disease. A wide range of different techniques have been established. There are no data which identify how current techniques have been integrated into clinical practice.

METHODS AND RESULTS: An electronic questionnaire was devised to identify SE practice in five core areas: service demographics, indications, methods, reporting, and adverse events. The questionnaire was sent to 198 National Health Service hospitals. Eighty-five (71%) out of the 120 departments who perform SE responded. Each unit performed a median of 400 SE (inter-quartile range 175-600). Thirty-two (37.6%) operators performed <100 SE per year. Exercise, dobutamine, dipyridamole, adenosine, and pacing SE were available in 57 (67.1%), 85 (100%), 6 (7.1%), 11 (12.9%), and 34 (40%) units, respectively. Eighty-one (95.3%) units performed SE for the evaluation of low-flow, low-gradient aortic stenosis. Thirty-four (40%) and 32 (37.6%) performed SE for the evaluation of asymptomatic severe aortic stenosis and symptomatic moderate mitral regurgitation, respectively. Eighty-three (97.6%) administered contrast agents during SE. Additional analysis of perfusion and strain was performed in 9 (10.5%) and 13 (15.3%) units, respectively.

CONCLUSION: SE has been incorporated into the majority of UK hospitals. A substantial proportion of operators perform less than the recommended number of procedures per year. The use of exercise SE, vasodilator SE, and SE for the evaluation of VHD are under-utilized. Penetration of new techniques is variable, contrast for left ventricular opacification has been almost universally adopted, while myocardial perfusion and mechanics are used much less.