Safety of stress echocardiography (from the International Stress Echo Complication Registry).
The safety of any diagnostic test is a major issue in deciding its practicability and cost-effectiveness. The aim of this study was to evaluate the safety of various stress echocardiographic modalities in the "real world." From February 1998 to January 2004, a simple written questionnaire was distributed to echocardiography laboratories across the world known to perform stress echocardiography. The following categories of major complications (known to occur during stress testing) were indicated: sustained ventricular tachycardia (> 30 beats/min), ventricular fibrillation, myocardial infarction, third-degree atrioventricular block, severe hypotension requiring therapy, cardiac asystole, cardiac rupture, stroke, and death. Three hundred centers were polled, from which 71 co-investigators responded and reported on 85,997 patient examinations. Exercise was used in 26,295 cases, dobutamine in 35,103, and dipyridamole in 24,599 cases. Life-threatening events occurred in 86 cases: during exercise in 4 patients (event rate 1 in 6,574), during dobutamine infusion (small dose for viability and/or large dose for ischemia) in 63 patients (event rate 1 in 557), and during dipyridamole stress testing in 19 patients (event rate 1 in 1,294). Of the 86 patients with complications, 5 died during dobutamine stress testing (ventricular fibrillation, n = 2; cardiac rupture, n = 3) and 1 after dipyridamole testing (cardiogenic shock). In conclusion, stress echocardiography is a safe method in the real world, but serious complications may occur. Exercise seems safer than pharmacologic stress and dipyridamole safer than dobutamine, possibly because of preselection criteria.
Varga
Albert
A
2nd Department of Medicine and Cardiology Center, University of Sciences, Szeged, Hungary. vargaa@in2nd.szote.u-szeged.hu
Garcia
Miguel Angel Rodriguez
MA
Picano
Eugenio
E
D002316:Cardiotonic Agents; D003362:Cost-Benefit Analysis; D004176:Dipyridamole; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000191:economics / Q000379:methods* / Q000592:standards; D015444:Exercise / Q000502:physiology*; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014665:Vasodilator Agents
D002316:Cardiotonic Agents; D014665:Vasodilator Agents; D004280:Dobutamine; D004176:Dipyridamole