title: Stress echocardiography in clinical practice: a United Kingdom National Health Service Survey on behalf of the British Society of Echocardiography.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology and Echocardiography Laboratory, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Bhattacharyya
authors.forename: Omar
authors.initials: O
authors.lastname: Chehab
authors.forename: Rajdeep
authors.initials: R
authors.lastname: Khattar
authors.forename: Guy
authors.initials: G
authors.lastname: Lloyd
authors.forename: Roxy
authors.initials: R
authors.lastname: Senior
mesh_terms: D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging*; D003287:Contrast Media; D025401:Echocardiography, Stress / Q000706:statistics & numerical data*; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012955:Societies, Medical; D013222:State Medicine; D011795:Surveys and Questionnaires; D006113:United Kingdom
chemical_list: D003287:Contrast Media
keywords: Coronary artery disease; Stress echocardiography; Valvular heart disease