Evaluation of stress echocardiography safety in Spain and Portugal

Introduction. There are few studies that evaluate the safety of stress echo cardiography with discordant results. They are done in well-trained centers with highly selected populations leading to selection bias. Objective. To assess the safety of the different modalities of stress echoc ardiography in Spain and Portugal. Method. Severe complications were retrospectively analyzed during the stres s echocardiography performed in 29 hospitals in Portugal and Spain, from th e beginning of their activity to September, 1999. In this period 22,105 str ess echocardiograms were permormed: 10,975 exercise echos, 2,969 low dose d obutamine echos, 6,832 high dose dobutamine echocardiograms, 1,276 dypirida mole echocardiograms, 41 paced echocardiograms and 12 with adenosine. A com plication was defined as severe when it was life-threatening or led to hosp ital admission. Results. We registered 26 complications, one death, 3 ventricular fibrillat ions, 10 sustained ventricular tachycardias, 2 complete atrioventricular bl ocks, 6 acute myocardial infarctions, 2 ruptures of the free wall or ventri cular septal defects, 1 transient ischemic attack and 1 severe symptomatic hypotension. We had one severe complication for every 2,743 exercise stress , 1 every 1,231 dypiridamole, 1 every 325 high dose dobutamine without any complications with low dose dobutamine stress. We found a relationship betw een experience in dobutamine stress echocardiography and the frequency of c omplications. Three complications appeared once the test was finished. Conclusions. The stress echocardiography is a safe technique, but not harml ess. The exercise stress echo is the safest of all the modalties of stress echocardiography. There is a relation between experience and the number of complications.