Skip to main content
Download PDF

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

Echo Research & Practice volume 5, pages 105–112 (2018)Cite this article

Abstract

Background:Dobutamine stress echocardiography (DSE) services have traditionally been medically led. In some UK institutions, DSE lists are led by physiologists with medical support. In our tertiary cardiac centre at New Cross Hospital (NCH), the DSE service was established by a consultant echocardiographer. Following intensive training and assessment, the Trust approved drug administration by named senior cardiac physiologists. We believe this is the first report of a cardiac physiologist-managed DSE service, including physiologist drug administration. We have assessed the feasibility, safety and validity of this physiologist-led DSE service.

Methods: Retrospective analysis of 333 patients undergoing stress echocardiogram for inducible reversible ischaemia, myocardial viability and valvular heart disease over 6 months. Patients’ case notes review after 18–24 months.

Results: Overall, 92% of all cases (306) were performed by physiologists. In 300 studies, dobutamine was administered. The majority of the referrals were for coronary artery disease (CAD) assessment (281). In 235 cases, the study was uncomplicated. Sixty-seven patients developed dobutamine-related side effects. In 16 cases, complications led to early termination of the study. In two cases, urgent medical review was needed. Of the 281 studies for CAD assessment, 239 were negative for ischaemia, 28 were positive and 14 inconclusive. In 5 out of 28 cases with echocardiogram, evidence of inducible ischaemia, coronary angiography revealed unobstructed coronary arteries.

Conclusion: This study demonstrates the safety and effectiveness of this practice and provides potential for the expansion of the physiologists’ role and physiologist-led DSE services in other hospitals.

References

  1. Senior R, Monaghan M, Becher H, Mayet J, Nihoyannopoulos P. Stress echocardiography for the diagnosis and risk stratification of patients with suspected or known coronary artery disease: a critical appraisal. Supported by the British Society of Echocardiography. Heart 200591 427–436. (https://doi.org/10.1136/hrt.2004.044396)

    Article  CAS  Google Scholar 

  2. Picano E, Pellikka PA. Stress echo applications beyond coronary artery disease. European Heart Journal 201435 1033–1040. (https://doi.org/10.1093/eurheartj/eht350)

    Article  Google Scholar 

  3. Becher H, Chambers J, Fox K, Jones R, Leech G, Masani N, Monaghan M, More R, Nihoyannopoulos P, Rimington H. 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 200490 vi23–vi30. (https://doi.org/10.1136/hrt.2004.047985)

    Article  Google Scholar 

  4. Mazeika PK, Nadazdin A, Oakley CM. Dobutamine stress echocardiography for detection and assessment of coronary artery disease. Journal of the American College of Cardiology 199219 1203–1211. (https://doi.org/10.1016/0735-1097(92)90325-H)

    Article  CAS  Google Scholar 

  5. Singh R, Kemp Z, Al-Janabi F, Kane S, Coles D. 106 New service: a cardiac physiologist managed exercise stress echo. Heart 2017103 A78–A79. (https://doi.org/10.1136/heartjnl-2017-311726.105)

    Article  Google Scholar 

  6. Khan J, Griffiths T, Fatima T, Michael L, Mihai A, Mustafa Z, Sandhu K, Butler R, Duckett S, Heatlie G. Feasibility of physiologist-led stress echocardiography for the assessment of coronary artery disease. Echo Research and Practice 20174 29–36. (https://doi.org/10.1530/ERP-17-0019)

    Article  Google Scholar 

  7. Popescu BA, Andrade MJ, Badano LP, Fox KF, Flachskampf FA, Lancellotti P, Varga A, Sicari R, Evangelista A, Nihoyannopoulos P, et al. European Association of Echocardiography recommendations for training, competence, and quality improvement in echocardiography. European Journal of Echocardiography 200910 893–905. (https://doi.org/10.1093/ejechocard/jep151)

    Article  Google Scholar 

  8. Luckraz H, Norell M, Buch M, James R, Cooper G. Structure and functioning of a multidisciplinary ‘Heart Team’ for patients with coronary artery disease: rationale and recommendations from a joint BCS/BCIS/SCTS working group. European Journal of Cardio-Thoracic Surgery 201548 524–529. (https://doi.org/10.1093/ejcts/ezv083)

    Article  Google Scholar 

  9. The Stationary Office. Statutory Instruments 2012 No. 1916 Medicines. The Human Medicines Regulations 2012. Norwich, UK: The Stationery Office, 2012. (available at: http://www.legislation.gov.uk/uksi/2012/1916/pdfs/uksi_20121916_en.pdf)

    Google Scholar 

  10. Department of Health. Medicines matters - July 2006. A guide to mechanisms for the prescribing, supply and administration of medicines. London, UK: NHS National Practitioner Programme and the Department of Health, 2006. (available at: http://webarchive.nationalarchives.gov.uk/20130123191451/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_064325)

    Google Scholar 

  11. Scally G, Donaldson LJ. Clinical governance and the drive for quality improvement in the new NHS in England. BMJ 1998317 61–65. (https://doi.org/10.1136/bmj.317.7150.61)

    Article  CAS  Google Scholar 

  12. National Institute for Health and Care Excellence (NICE). Chest pain of recent onset: assessment and diagnosis (CG95), 2010. London, UK: NICE (available at: https://www.nice.org.uk/guidance/cg95)

    Google Scholar 

  13. Indrajith M, Garbi M, Monaghan MJ. Setting up a stress echo service: best practice. Heart 2016102 1763–1770. (https://doi.org/10.1136/heartjnl-2015-308165)

    Article  Google Scholar 

  14. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell D, Rumberger J, Ryan T, Veraniet M. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002105 539–542. (https://doi.org/10.1161/hbib402.10297)

    Article  Google Scholar 

  15. Picano E, Pibarot P, Lancelloti P, Monin JL, Bonow R. The emerging role of exercise testing and stress echocardiography in valvular heart disease. Journal of the American College of Cardiology 200954 2251–2260. (https://doi.org/10.1016/j.jacc.2009.07.046)

    Article  Google Scholar 

  16. Senior R, Becher H, Monaghan M, Agati L, Zamorano J, Vanoverschelde JL, Nihoyannopoulos P. Contrast echocardiography: evidence-based recommendations by European Association of Echocardiography. European Journal of Echocardiography 200910 194–212. (https://doi.org/10.1093/ejechocard/jep005)

    Article  Google Scholar 

  17. Varga A, Garcia MA, Picano E & International Stress Echo Complication Registry. Safety of stress echocardiography (from the International Stress Echo Complication Registry). American Journal of Cardiology 200698 541–543. (https://doi.org/10.1016/j.amjcard.2006.02.064)

    Article  Google Scholar 

  18. Turakhia MP, McManus DD, Whooley MA, Schiller NB. Increase in end-systolic volume after exercise independently predicts mortality in patients with coronary heart disease: data from the Heart and Soul Study. European Heart Journal 200930 2478–2484. (https://doi.org/10.1093/eurheartj/ehp270)

    Article  Google Scholar 

  19. Clavel MA, Magne J, Pibarot P. Low-gradient aortic stenosis, European Heart Journal 201637 2645–2657. (https://doi.org/10.1093/eurheartj/ehw096)

    Article  Google Scholar 

  20. BCS. Strategic Review of Cardiac Physiology Services in England: Final Report. London, UK: British Cardiovascular Society, 2015. (available at: http://www.bcs.com/documents/SRCPS_Final_Report_12052015_2.pdf)

    Google Scholar 

  21. DOH. Modernising Scientific Careers: The England Action Plan. London, UK: Department of Health, 2010. (available at: https://www.gov.uk/government/publications/modernising-scientific-careers-the-england-action-plan)

    Google Scholar 

  22. Beleslin BD, Ostojic M, Djordjevic-Dikic A, Babic R, Nedeljkovic M, Stankovic G, Stojkovic S, Marinkovic J, Nedeljkovic D, Stepanovic J, et al. Integrated evaluation of relation between coronary lesion features and stress echocardiography results: the importance of coronary lesion morphology. Journal of the American College of Cardiology 199933 717–726. (https://doi.org/10.1016/S0735-1097(98)00613-5)

    Article  CAS  Google Scholar 

  23. Sicari R, Nihoyannopoulos P, Evangelista A, Kasprzak J, Lancellotti P, Poldermans D, Voigt JU, Jose Luis Zamorano JL. Stress echocardiography expert consensus statement–executive summary: European Association of Echocardiography (EAE). European Heart Journal 200930 278–289. (https://doi.org/10.1093/eurheartj/ehn492)

    Article  Google Scholar 

  24. Picano E, Molinaro S, Pasanisi E. The diagnostic accuracy of pharmacological stress echocardiography for the assessment of coronary artery disease: a meta-analysis. Cardiovascular Ultrasound 20086 30. (https://doi.org/10.1186/1476-7120-6-30)

    Article  Google Scholar 

  25. Marwick T. Stress echocardiography. Heart 200389 113–118. (https://doi.org/10.1136/heart.89.1.113)

    Article  Google Scholar 

  26. Geleijnse ML, Krenning BJ, Nemes A, van Dalen BM, Soliman OI, Ten Cate FJ, Schinkel A, Boersma E, Simoons M. Incidence, pathophysiology, and treatment of complications during dobutamine-atropine stress echocardiography. Circulation 2010121 1756–1767. (https://doi.org/10.1161/CIRCULATIONAHA.109.859264)

    Article  Google Scholar 

  27. Secknus MA, Marwick TH. Evolution of dobutamine echocardiography protocols and indications: safety and side effects in 3011 studies over 5 years, Journal of the American College of Cardiology 199729 1234–1240. (https://doi.org/10.1016/S0735-1097(97)00039-9)

    Article  CAS  Google Scholar 

Download references

Funding

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Author information

Authors and Affiliations

  1. Department of Cardiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK

    Theodoros Ntoskas MD, Farhanda Ahmad PgDMU & Paul Woodmansey MD FRCP

Authors
  1. Theodoros Ntoskas MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Farhanda Ahmad PgDMU
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul Woodmansey MD FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Theodoros Ntoskas MD.

Rights and permissions

This work is licensed under a Creative Commons Attribution 4.0 International License.(http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ntoskas, T., Ahmad, F. & Woodmansey, P. Safety and efficacy of physiologist-led dobutamine stress echocardiography: experience from a tertiary cardiac centre. Echo Res Pract 5, 105–112 (2018). https://doi.org/10.1530/ERP-18-0038

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1530/ERP-18-0038

Key Words

Echo Research & Practice

ISSN: 2055-0464

Contact us