ArticleEuropean heart journal. Cardiovascular Imaging2025
Long-term outcomes after stress echocardiography in real-world practice: a 5-year follow-up of the UK EVAREST study.
Article in European heart journal. Cardiovascular Imaging, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
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Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Prognostic relevance of a false-positive stress echocardiography response: a systematic review and meta-analysis.Open heart · 2025Pooled it
- Long-term prognostic value of myocardial perfusion scintigraphy in patients with suspected coronary artery disease: systematic review and meta-analysis.Open heart · 2025Pooled it
- A proposal of an echocardiography-based pathway for the diagnosis and management of angina with no obstructive coronary arteries: a state-of-the-art review: Advancing Targeted Therapy and Prognosis Through Endotype Identification.European heart journal. Imaging methods and practice · 2026Review
- The FINESSE (Artificial Intelligence Stress Echo) study to develop and validate machine learning-based model to improve risk prediction in patients undergoing stress echocardiography for the assessment of inducible myocardial ischaemia (FINESSE Protocol).European heart journal. Imaging methods and practice · 2026Article
- The Effect of Rate-Controlling Medication on the Performance and Outcome of Dobutamine Stress Echocardiography in the Assessment of Patients with Suspected Angina: A Retrospective Cohort Study.Journal of clinical medicine · 2026Article
- Coronary anatomy detects, ischemia predicts: Real-world insights from the Nancy ischemia registry.International journal of cardiology. Heart & vasculature · 2026Article
- Contemporary review of stress echocardiography workforce within the UK: an EVAREST/BSE NSTEP study.Echo research and practice · 2025Article
- Prognostic value of adenosine stress echocardiography in chronic coronary syndromes with preserved left ventricular ejection fraction.Cardiovascular ultrasound · 2025Article
- Clinical research and trials in echocardiography: rationale, requirements and future opportunities.Echo research and practice · 2025Review
- Stress Echocardiography Revisited: Toward Improving Patient Selection and Clinical Decision-Making.Echocardiography (Mount Kisco, N.Y.) · 2025Article
- Changes in coronary disease management decisions in real-world practice between 2015 and 2023: insights from the EVAREST/BSE-NSTEP observational study.European heart journal. Cardiovascular Imaging · 2025Observational
- Guillain-Barré Syndrome Presenting With New-Onset Heart Failure.Journal of investigative medicine high impact case reportsArticle
Corrections and comments
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Authors and funding
17 authors.
Funding
Abstract
aimsStress echocardiography is widely used to assess patients with chest pain. The clinical value of a positive or negative test result to inform on likely longer-term outcomes when applied in real-world practice across a healthcare system has not been previously reported. METHODS AND
resultsFive thousand five hundred and three patients recruited across 32 UK NHS hospitals between 2018 and 2022, participating in the EVAREST/BSE-NSTEP prospective cohort study, with data on medical outcomes up to 2023 available from NHS England were included in the analysis. Stress echocardiography results were related to outcomes, including death, procedures, hospital admissions, and relevant cardiovascular diagnoses, based on Kaplan-Meier analysis and Cox proportional hazard ratios (HRs). Median follow-up was 829 days (interquartile range 224-1434). A positive stress echocardiogram was associated with a greater risk of myocardial infarction [HR 2.71, 95% confidence interval (CI) 1.73-4.24, P < 0.001] and a composite endpoint of cardiac-related mortality and myocardial infarction (HR 2.03, 95% CI 1.41-2.93, P < 0.001). Hazard ratios increased with ischaemic burden. A negative stress echocardiogram identified an event-free 'warranty period' of at least 5 years in patients with no prior history of coronary artery disease and 4 years for those with disease.
conclusionIn real-world practice, the degree of myocardial ischaemia recorded by clinicians at stress echocardiography correctly categorizes risk of future events over the next 5 years. Reporting a stress echocardiogram as negative correctly identifies patients with no greater than a background risk of cardiovascular events over a similar time period.
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