P796 Feasibility of exercise stress echocardiography and its correlation with angiographically significant coronary disease

Abstract

Abstract Background European Society of Cardiology (ESC) guidelines on the management of stable coronary artery disease (CAD) advocate stress echocardiography (SE) as a first line assessment for functionally significant ischaemia. Pharmacological stressors such as dobutamine are typically utilised in most UK centres in view of practical benefits when compared with treadmill testing. However, exercise provides the best physiological mimic and enables additional data on haemodynamics and electrocardiogram (ECG) changes to be obtained. Purpose To assess the feasibility and safety of exercise stress echocardiography (ESE), and the correlation of positive testing with significant coronary disease and major adverse cardiovascular events. Methods A retrospective, single-centre analysis of 500 consecutive patients undergoing ESE for investigation of stable CAD. Cases were excluded when a pharmacological stressor was utilised, or in contexts where ESE was performed for other clinical indications. ESE reports were interrogated for patient demographics, co-morbidities, achievement of target heart rate (HR), procedural sequelae, image quality and findings. Electronic records were reviewed after 24 months to assess results of invasive angiography, when performed, and long-term outcomes including myocardial infarction (MI) and cardiovascular mortality. Concordance between ischaemic territory on ESE and coronary lesions on angiography was also collated. Results 95% (475/500) of patients were suitable for inclusion. Of these, 83% (394/475) achieved target HR. Sequelae arose in 0.02% (9/475), with the most frequent being ectopy (4 cases). Image quality was adequate in 98% (465/475), with the requirement for contrast agent in the remainder. There were no significant differences in burden of cardiovascular risk factors between the positive and negative ESE groups. 13% (63/475) were positive for inducible ischaemia in one or more myocardial segments. Of these, 71% (45/65) underwent angiography, with 48% (31/65) requiring stenting or bypass surgery. Ischaemic territory on ESE correlated with angiographic lesions in 65% (29/45) of cases. ESE underestimated extent of significant CAD in only 7% (3/45). In the subcohort positive for ESE, 3% (2/63) suffered a MI and cardiovascular mortality was 1.5% (1/63). Conclusions ESE is a safe, non-invasive modality for functional testing that reaches diagnostic threshold in the vast majority of cases. It has reasonable concordance in localising ischaemic coronary territory to enable targeted revascularisation.