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.
Highlights
Stress echocardiography (SE) is a well-established, reliable and safe method for assessment of ischaemic heart disease [1]
As this article is about the effectiveness and safety of the physiologist-led dobutamine stress echocardiography (PLDSE) and because the overwhelming majority of the studies were performed by physiologists, the following data analysis and discussion focuses on the outcomes of the tests performed by the cardiac physiologist team
The remainder of the Dobutamine stress echocardiography (DSE) requests were to clarify the severity of aortic valve stenosis in patients with significantly impaired left ventricle (LV) systolic function and low flow and low gradient aortic valve stenosis [19]
Summary
Stress echocardiography (SE) is a well-established, reliable and safe method for assessment of ischaemic heart disease [1]. Dobutamine stress echocardiography (DSE) services have traditionally been medically led. 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. 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
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