Feasibility, efficacy and safety of exercise stress echocardiography during the COVID-19 pandemic

OBJECTIVE: To assess the feasibility, efficacy and safety of performing exercise stress echocardiography (ESE) for the assessment of myocardial ischaemia during the COVID-19 pandemic. METHODS AND RESULTS: Baseline data were collected prospectively on 740 consecutive patients (mean age 61.4 years, 56.8% males), referred for a stress echocardiogram (SE), who underwent ESE between July 2020 (immediate post lockdown) and January 2021 according to national safety guidelines, in addition to patients wearing masks during ESE. Retrospective analysis was performed on follow-up data for outcomes. Propensity score matching was used to compare workload achieved during ESE pre-COVID-19, in 768 consecutive patients who underwent ESE between May 2014 and May 2015. Of the 725 (97.9%) diagnostic tests obtained, 69 (9.3%) demonstrated significant inducible ischaemia (≥3 segments) with no serious adverse events. Of the 61 patients who underwent coronary angiography, 51 (83%) demonstrated flow-limiting coronary artery disease. During a mean follow-up period of 4.6 months, one first-cardiac event was recorded. Compliance with mask-wearing throughout ESE was seen in 98.7% of patients. Of the 17 healthcare professionals performing ESE, none contracted COVID-19 during this period. SE service performance increased to 96.8% of prepandemic levels (100%) from 26.6% at the start of July 2020 to the end of December 2020. Propensity-matched data showed no significant difference in exercise workload between patients undergoing ESE during and prepandemic. CONCLUSION: Performing ESE during the COVID-19 pandemic, with safety measures in place, is feasible, efficacious and safe. It impacted on the time patients were waiting to undergo a diagnostic test and yielded appropriate outcomes. Service evaluation authorisation of research capability number SE20/059.