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BSE procedure guidelines for the clinical application of stress echocardiography, recommendations for performance and interpretation of stress echocardiography
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  1. H Becher,
  2. J Chambers,
  3. K Fox,
  4. R Jones,
  5. G J Leech,
  6. N Masani,
  7. M Monaghan,
  8. R More,
  9. P Nihoyannopoulos,
  10. H Rimington,
  11. R Senior,
  12. G Warton
  1. British Society of Echocardiography, c/o British Cardiac Society, 9 Fitzroy Square, London W1T 5HW, UK
  1. Correspondence to:
    Dr Harald Becher
    John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; harald.becherorh.nhs.uk

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The British Society of Echocardiography (BSE) procedure guidelines for the clinical application of stress echocardiography, recommendations for performance and interpretation of stress echocardiography are presented here.

1. BACKGROUND

The objective of guidelines is to enhance appropriateness of practice, improve quality of care, lead to better patient outcomes, and help authorities to decide on the approval of diagnostic or therapeutic procedures. For patients with coronary artery disease (CAD), one of the greatest challenges of our heath care system, a variety of diagnostic procedures is available at varying financial burdens. In order to improve cost effectiveness precise guidelines are needed to advise physicians.1

Stress echocardiography has become a valuable method for cardiovascular stress testing. It plays a crucial role in the initial detection of coronary artery disease, in determining prognosis and in therapeutic decision making.2,3 These recommendations refer to the use of stress echocardiography to assess myocardial ischaemia or viability in patients with coronary artery disease. Evaluation of valvar heart disease or cardiomyopathies is not included but the BSE will provide separate guidelines for these indications in the future.

Stress echocardiography is part of a diagnostic process, which often includes several diagnostic modalities, some of them complementary (for example, stress ECG), others competitive (for example, myocardial scintigraphy or magnetic resonance imaging (MRI)). This is reflected in this document, which outlines the indications and contraindications for stress echocardiography, the recommended methodology, and the clinical use of this technique. This document is intended to supplement other guidelines for cardiovascular stress testing, including the recently published guidelines for myocardial scintigraphy.4,5

Guidelines have to reflect the specific situation of the local health system and have to be updated to reflect the technical developments of the procedure and the developments of competing procedures. In particular there has been an increasing use of new imaging …

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