[Dobutamine stress echocardiography: Appropriateness of indications and protocol compliance. A single-centre report]

Dobutamine stress echocardiography is widely used in the evaluation of chronic coronary syndrome and silent myocardial ischaemia. Since 2017, its cost in France has increased following its integration into the diagnosis-related group reimbursement system, raising concerns regarding cost-effectiveness. We assessed the appropriateness of indications and compliance with current recommendations at our institution.

We retrospectively analysed all dobutamine stress echocardiograms performed at Sainte-Anne Military Hospital during the 2023-2024 academic year. For each examination, we collected patient characteristics, indications, treatments, electrocardiographic data, and echocardiographic findings.

A total of 111 consecutive patients were included. The population was predominantly male (71%), with a mean age of 71.2 years. In total, 41.4% of patients had three or more cardiovascular risk factors. The examination was performed as part of routine follow-up of known coronary artery disease in 45.9% of cases and for the investigation of angina in 14.4%. Twenty-one patients (18.9%) had already undergone coronary assessment within the preceding 24 months. Image quality was acceptable or better in 90% of cases at rest and 79% at peak stress. Contrast agents were used in only two patients. Wall motion abnormalities were detected in 2.7% of cases. Sixteen patients underwent coronary angiography following the examination, of whom eight were revascularised.

Most examinations were performed in asymptomatic patients, although recent European guidelines no longer support this systematic screening approach. Optimising patient selection and broader adoption of multiparametric protocols could improve diagnostic yield, safety, and cost-efficiency of the examination.