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Richard P Steeds, Richard Wheeler, Sanjeev Bhattacharyya, Joseph Reiken, Petros Nihoyannopoulos, Roxy Senior, Mark J Monaghan, and Vishal Sharma

Stress echocardiography is an established technique for assessing coronary artery disease. It has primarily been used for the diagnosis and assessment of patients presenting with chest pain in whom there is an intermediate probability of coronary artery disease. In addition, it is used for risk stratification and to guide revascularisation in patients with known ischaemic heart disease. Although cardiac computed tomography has recently been recommended in the United Kingdom as the first-line investigation in patients presenting for the first time with atypical or typical angina, stress echocardiography continues to have an important role in the assessment of patients with lesions of uncertain functional significance and patients with known ischaemic heart disease who represent with chest pain. In this guideline from the British Society of Echocardiography, the indications and recommended protocols are outlined for the assessment of ischaemic heart disease by stress echocardiography.

Open access

Cameron Dockerill, William Woodward, Annabelle McCourt, Cristiana Monteiro, Elena Benedetto, Maria Paton, David Oxborough, Shaun Robinson, Keith Pearce, Mark J Monaghan, Daniel X Augustine, and Paul Leeson


Healthcare delivery is being transformed by COVID-19 to reduce transmission risk but continued delivery of routine clinical tests is essential. Stress echocardiography is one of the most widely used cardiac tests in the NHS. We assessed the impact of the first (W1) and second (W2) waves of the pandemic on the ability to deliver stress echocardiography.


Clinical echocardiography teams in 31 NHS hospitals participating in the EVAREST study were asked to complete a survey on the structure and delivery of stress echocardiography as well as its impact on patients and staff in July and November 2020. Results were compared to stress echocardiography activity in the same centre during January 2020.


24 completed the survey in July, and 19 NHS hospitals completed the survey in November. A 55% reduction in the number of studies performed was reported in W1, recovering to exceed pre-COVID rates in W2. The major change was in the mode of stress delivery. 70% of sites stopped their exercise stress service in W1, compared to 19% in W2. In those still using exercise during W1, 50% were wearing FFP3/N95 masks, falling to 38% in W2. There was also significant variability in patient screening practices with 7 different pre-screening questionnaires used in W1 and 6 in W2.


Stress echocardiography delivery restarted effectively after COVID-19 with adaptations to reduce transmission that means activity has been able to continue, and exceed, pre-COVID-19 levels during the second wave. Further standardization of protocols for patient screening and PPE may help further improve consistency of practice within the United Kingdom.

Open access

Keith Pearce and John Chambers

-analysis . Journal of the American College of Cardiology 2007 49 227 – 237 . ( ) 10.1016/j.jacc.2006.08.048 4 Sicari R Cortigiani L . The clinical use of stress echocardiography in ischaemic heart disease

Open access

Theodoros Ntoskas, Farhanda Ahmad, and Paul Woodmansey

Introduction Stress echocardiography (SE) is a well-established, reliable and safe method for assessment of ischaemic heart disease ( 1 ). Furthermore, SE is utilised in patients with valvular heart disease or cardiomyopathies and is also used

Open access

Jet van Zalen, Nikhil R Patel, Steven J Podd, Prashanth Raju, Rob McIntosh, Gary Brickley, Louisa Beale, Lydia P Sturridge, and Guy W L Lloyd

receive CRT and the remaining 27 did not qualify for CRT at the time of the study. Although no significant differences were found for the presence of ischaemic heart disease, there was a trend observed for hospitalisation ( P =0.25) and survival ( P =0

Open access

Peter H Waddingham, Sanjeev Bhattacharyya, Jet Van Zalen, and Guy Lloyd

in terms of population demographics and represented the heterogenous patient population with non-ischaemic systolic HF. The clinical definitions for patients with DCM and exclusion methods for ischaemic heart disease were compared, and these often

Open access

Girish Dwivedi, Ganadevan Mahadevan, Donie Jimenez, Michael Frenneaux, and Richard P Steeds

ischaemic heart disease and atrial fibrillation) were invited to undergo echocardiography. Patients aged 60–85 were included in the screening study, the details of which have been published previously (7) . Exclusion criteria for this echocardiographic sub

Open access

P A Patel, K A Ravi, D P Ripley, J Kane, E Wass, A Carr, D Wilson, N Watchorn, R K Hobman, D Gill, W P Brooksby, N Kilcullen, and N Artis

Ortoft K & Nylander E 2003 Chest pain and ischaemic heart disease in primary care . British Journal of General Practice 53 378 – 382 . 2 Klinkman MS Stevens D & Gorenflo DW 1994 Episodes of care for chest pain: a preliminary

Open access

John B Chambers

regurgitation are not at risk and can have exercise using a standard Bruce protocol with the same number of exercise physiologists as for a test for ischaemic heart disease. Patients with aortic or mitral stenosis are more likely to be elderly and may also have

Open access

James Yates, Colin Forbes Royse, Carolyn Royse, Alistair George Royse, and David Jeffrey Canty

was 66 ( s.d. 13.1) years and 59% were female. Patient co-morbid diseases included cigarette smoking (42.5%), hypertension (47.5%), ischaemic heart disease (12.5%), diabetes mellitus (8.8%), chronic obstructive pulmonary disease (7.5%), interstitial