Real-world performance and accuracy of stress echocardiography: the EVAREST observational multi-centre study

Abstract

Aims Stress echocardiography is widely used to identify obstructive coronary artery disease (CAD). High accuracy is reported in expert hands but is dependent on operator training and image quality. The EVAREST study provides UK-wide data to evaluate real-world performance and accuracy of stress echocardiography. Methods and results Participants undergoing stress echocardiography for CAD were recruited from 31 hospitals. Participants were followed up through health records which underwent expert adjudication. Cardiac outcome was defined as anatomically or functionally significant stenosis on angiography, revascularization, medical management of ischaemia, acute coronary syndrome, or cardiac-related death within 6 months. A total of 5131 patients (55% male) participated with a median age of 65 years (interquartile range 57–74). 72.9% of studies used dobutamine and 68.5% were contrast studies. Inducible ischaemia was present in 19.3% of scans. Sensitivity and specificity for prediction of a cardiac outcome were 95.4% and 96.0%, respectively, with an accuracy of 95.9%. Sub-group analysis revealed high levels of predictive accuracy across a wide range of patient and protocol sub-groups, with the presence of a resting regional wall motion abnormalitiy significantly reducing the performance of both dobutamine (P < 0.01) and exercise (P < 0.05) stress echocardiography. Overall accuracy remained consistently high across all participating hospitals. Conclusion Stress echocardiography has high accuracy across UK-based hospitals and thus indicates stress echocardiography is being delivered effectively in real-world practice, reinforcing its role as a first-line investigation in the assessment of patients with stable chest pain.

Peak treadmill exercise echocardiography for ischemia detection

“…In a recent large multicentric study with ExE (treadmill or bicycle) performed in 1375 patients the median BSI was as much as 27.4 kg/m 2 (IQR 24.5–30.5). Despite it, the figures for sensitivity and specificity resulted remarkable 21 …”

“…Upright bicycle performs in an intermediate position regarding heart rate and O2 consumption 11 . Table 2 depicts main studies that have compared different ExE modalities, 9,10,12–18 whereas Table 3 shows sensitivities and specificities of various stress echocardiography modalities, including ExE studies 8,10,14,17,19–24 . Overall, sensitivity of ExE is around 80%–85%, although figures for peak imaging are 85%–90%.…”

“…Despite it, the figures for sensitivity and specificity resulted remarkable. 21 Second, examination during an ExE is harder than during a stress echocardiogram with drugs, because both heart rate and respiratory rate increase comparatively more with exercise. It has been asserted…”

“…10 9,10,[12][13][14][15][16][17][18] whereas Table 3 shows sensitivities and specificities of various stress echocardiography modalities, including ExE studies. 8,10,14,17,[19][20][21][22][23][24] Overall, sensitivity of ExE is around 80%-85%, although figures for peak imaging are 85%-90%.…”

Left ventricular assessment with artificial intelligence increases the diagnostic accuracy of stress echocardiography

“…Stress echocardiography (SE) is one of the most widely performed, accessible, and cost-effective procedures for both the diagnosis and risk stratification of patients with known or suspected coronary artery disease (CAD). 1 Although wall motion scoring (WMS) of SEs by expert readers has a high accuracy for identifying CAD, the inherent reliance on this subjective assessment can lead to significant variability in accuracy between centres and operators. 2 …”