Feasibility of physiologist-led stress echocardiography for the assessment of coronary artery disease

Abstract

BackgroundPhysiologist-led stress echocardiography (PLSE) services provide potential for expansion of SE services and increased productivity for cardiologists. There are however no published data on the feasibility of PLSE. We sought to assess the feasibility, safety and robustness of PLSE and cardiologist-led stress echocardiography (CLSE) for coronary artery disease (CAD) assessment.MethodsRetrospective analysis of 898 patients undergoing PLSE or CLSE for CAD assessment using exercise or dobutamine stress over 24 months. PLSE involved 2 cardiac physiologists (exercise) or 1 physiologist plus 1 cardiac nurse (dobutamine). A cardiology registrar was present in the echocardiography department during PLSE in case of medical complications. CLSE involved 1 physiologist and 1 trainee cardiologist who analysed the study and reviewed findings with an imaging cardiologist. Sixteen-segment wall motion scoring (WMS, WMSI) analysis was performed. Feasibility (stressor, image quality, proportion of completed studies, agreement with imaging cardiologist analysis) and safety (complication rate) were compared for PLSE and CLSE.ResultsThe majority of studies were CLSE (56.2%) and used dobutamine (68.7%). PLSE more commonly used exercise (69.2%). Overall, 96% of studies were successfully completed (>14 diagnostic segments in 98%, P = 0.899 PLSE vs CLSE). Commencement of PLSE was associated with an increase in annual SE’s performed for CAD assessment. Complication rates were comparably very low for PLSE and CLSE (0.8% vs 1.8%, P = 0.187). There was excellent agreement between PLSE and CLSE WMS interpretation of 480 myocardial segments at rest (κ = 0.87) and stress (κ = 0.70) and WMSI (ICCs and Pearson’s r >0.90, zero Bland–Altman mean bias).ConclusionThis to our knowledge is the first study of the feasibility of PLSE. PLSE performed by well-trained physiologists is feasible and safe in contemporary practice. PLSE and CLSE interpretation of stress echocardiography for CAD agree very closely.

Sustainability and Versatility of the ABCDE Protocol for Stress Echocardiography

“…The methodology uses two-dimensional echocardiography technology for patients with known or suspected CAD and involves the assessment of RWMA with the naked eye. This approach has obvious merits since it provides a highly specific marker of myocardial ischemia and underlying epicardial CAD, which provides the ability for excellent risk stratification, it has an outstanding safety record even with pharmacological stress and contrast, and an unsurpassed cost-benefit profile [ 9 , 10 ]. However, there are several limitations.…”

Stress echocardiography in coronary artery disease: a practical guideline from the British Society of Echocardiography

“…A minimum of two individuals are required for every case. The first operator usually performs the echocardiography and can be any health professional with the appropriate skill and experience (17). The health professional should not only be fully trained in transthoracic echocardiography (BSE TTE Proficiency Accreditation or equivalent), but it is desirable for practitioners to undergo additional training in the acquisition of SE images, such as the BSE Accreditation in SE or international equivalent (2).…”

Safety and efficacy of physiologist-led dobutamine stress echocardiography: experience from a tertiary cardiac centre

“…Dobutamine is the preferred pharmacological stressor ( 4 ). There are a number of hospitals in the United Kingdom, where physiologists lead safe and effective SE services especially in the evaluation of CAD ( 5 , 6 ). However, to our knowledge, in these other centres dobutamine and other intravenous drugs are administered by a nurse or doctor.…”