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Erschienen in: Wiener klinische Wochenschrift 13-14/2015

01.07.2015 | original article

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

verfasst von: David Weidenauer, MD, Philipp Bartko, MD, PhD, Heidemarie Zach, MD, Manfred Zehetgruber, MD, Hans Domanovits, MD, Senta Graf, MD, Gerald Mundigler, MD

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 13-14/2015

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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.
Literatur
1.
Zurück zum Zitat 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.PubMedCentralPubMedCrossRef 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.PubMedCentralPubMedCrossRef
2.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
3.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
4.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
5.
Zurück zum Zitat Cullen MW, Pellikka PA. Recent advances in stress echocardiography. Curr Opin Cardiol. 2011;26:379–84.PubMedCrossRef Cullen MW, Pellikka PA. Recent advances in stress echocardiography. Curr Opin Cardiol. 2011;26:379–84.PubMedCrossRef
6.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
7.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
8.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
9.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
10.
Zurück zum Zitat Picano E, Pellikka PA. Stress echo applications beyond coronary artery disease. Eur Heart J. 2014;35:1033–40.PubMedCrossRef Picano E, Pellikka PA. Stress echo applications beyond coronary artery disease. Eur Heart J. 2014;35:1033–40.PubMedCrossRef
11.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
12.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
13.
Zurück zum Zitat 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.PubMedCentralPubMedCrossRef 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.PubMedCentralPubMedCrossRef
14.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
15.
Zurück zum Zitat Aumiller J. Neue Herzstatistik: Herzbericht 2005. Herz. 2006;31:811–3. Aumiller J. Neue Herzstatistik: Herzbericht 2005. Herz. 2006;31:811–3.
16.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
17.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
18.
Zurück zum Zitat 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.PubMedCentralPubMed 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.PubMedCentralPubMed
19.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
20.
Zurück zum Zitat Lancellotti P, Magne J Stress echocardiography in regurgitant valve disease. Circ Cardiovasc Imaging. 2013;6:840–9.PubMedCrossRef Lancellotti P, Magne J Stress echocardiography in regurgitant valve disease. Circ Cardiovasc Imaging. 2013;6:840–9.PubMedCrossRef
21.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
22.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
23.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
24.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
25.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
26.
Zurück zum Zitat Weidemann F, Herrmann S, Stork S, et al. Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis. Circulation. 2009;120:577–84.PubMedCrossRef Weidemann F, Herrmann S, Stork S, et al. Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis. Circulation. 2009;120:577–84.PubMedCrossRef
27.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
28.
Zurück zum Zitat Tsutsui JM, Elhendy A, Anderson JR, et al. Prognostic value of dobutamine stress myocardial contrast perfusion echocardiography. Circulation. 2005;112:1444–50.PubMedCrossRef Tsutsui JM, Elhendy A, Anderson JR, et al. Prognostic value of dobutamine stress myocardial contrast perfusion echocardiography. Circulation. 2005;112:1444–50.PubMedCrossRef
29.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
Metadaten
Titel
Stress-echocardiography is underused in clinical practice: a nationwide survey in Austria
verfasst von
David Weidenauer, MD
Philipp Bartko, MD, PhD
Heidemarie Zach, MD
Manfred Zehetgruber, MD
Hans Domanovits, MD
Senta Graf, MD
Gerald Mundigler, MD
Publikationsdatum
01.07.2015
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 13-14/2015
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-015-0828-1

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