Most dobutamine stress echocardiograms performed at our institution were conducted in asymptomatic patients, although recent European guidelines no longer support this systematic screening approach, suggesting a need to optimise patient selection and adopt multiparametric protocols.
The study population was predominantly male with a high cardiovascular risk factor burden.
The most common indication for dobutamine stress echocardiography was routine follow-up of known coronary artery disease.
A notable proportion of patients had already undergone coronary assessment within the preceding 24 months prior to the dobutamine stress echocardiogram.
Image quality was acceptable at rest in most cases but declined at peak stress, and contrast agents were rarely used.
Wall motion abnormalities were detected in a small proportion of cases, and roughly half of patients who underwent subsequent coronary angiography were revascularised.
This research examined how appropriately dobutamine stress echocardiography (a cardiac stress test using medication to simulate exercise while imaging the heart with ultrasound) was being used at a single French military hospital over one academic year. The study looked at 111 patients who underwent the test and evaluated whether the reasons for ordering the test matched current medical guidelines, and whether the test was being performed according to recommended protocols. The study found that the most common reason for ordering the test was routine monitoring of patients already known to have coronary artery disease, and that most tests were performed in patients who had no symptoms. However, current European guidelines no longer recommend this kind of routine, systematic screening in asymptomatic patients. Additionally, nearly one in five patients had already had a coronary evaluation within the previous two years, raising questions about whether repeated testing was necessary. The test detected meaningful abnormalities (wall motion problems) in only about 1 in 37 patients, and image quality at peak stress was suboptimal in about 1 in 5 cases, partly because a contrast agent to improve image quality was almost never used. This research suggests that there is room to improve how this test is used: better patient selection focusing on symptomatic individuals, and more consistent use of recommended techniques such as contrast agents and multiparametric protocols, could make the test more effective, safer, and more cost-efficient. This is particularly relevant in France, where the reimbursement structure for the test changed in 2017, making appropriate use increasingly important from a healthcare cost perspective.
Demoulin R, Prevautel T, Schmitt P, Adet A, Capilla E, Rohel G, et al.. (2026). [Dobutamine stress echocardiography: Appropriateness of indications and protocol compliance. A single-centre report].. Annales de cardiologie et d'angeiologie. https://doi.org/10.1016/j.ancard.2026.102016