TY - JOUR
T1 - Multiple Phenotypes of Chronic Coronary Syndromes Identified by ABCDE Stress Echocardiography
AU - Stress Echo 2030 Study Group
AU - Gaibazzi, Nicola
AU - Ciampi, Quirino
AU - Cortigiani, Lauro
AU - Wierzbowska-Drabik, Karina
AU - Zagatina, Angela
AU - Djordjevic-Dikic, Ana
AU - Manganelli, Fiore
AU - Boshchenko, Alla
AU - Borguezan-Daros, Clarissa
AU - Arbucci, Rosina
AU - Marconi, Sofia
AU - Lowenstein, Jorge
AU - Haberka, Maciej
AU - Celutkiene, Jelena
AU - D'Andrea, Antonello
AU - Rodriguez-Zanella, Hugo
AU - Rigo, Fausto
AU - Monte, Ines
AU - Costantino, Marco Fabio
AU - Ostojic, Miodrag
AU - Merli, Elisa
AU - Pepi, Mauro
AU - Carerj, Scipione
AU - Kasprzak, Jaroslaw D.
AU - Pellikka, Patricia A.
AU - Picano, Eugenio
N1 - Publisher Copyright:
© 2023 American Society of Echocardiography
PY - 2024
Y1 - 2024
N2 - Background: Regional wall motion abnormality is considered a sensitive and specific marker of ischemia during stress echocardiography (SE). However, ischemia is a multifaceted entity associated with either coronary artery disease (CAD) or angina with normal coronary arteries, a distinction difficult to make using a single sign. The aim of this study was to evaluate the diagnostic potential of the five-step ABCDE SE protocol for CAD detection. Methods: From the 2016–2022 Stress Echo 2030 study data bank, 3,229 patients were selected (mean age, 66 ± 12 years; 2,089 men [65%]) with known CAD (n = 1,792) or angina with normal coronary arteries (n = 1,437). All patients were studied using both the ABCDE SE protocol and coronary angiography, within 3 months. In step A, regional wall motion abnormality is assessed; in step B, B-lines and diastolic function; in step C, left ventricular contractile reserve; in step D, coronary flow velocity reserve in the left anterior descending coronary artery; and in step E, heart rate reserve. Results: SE response ranged from a score of 0 (all steps normal) to a score of 5 (all steps abnormal). For CAD, rates of abnormal results were 347 for step A (19.4%), 547 (30.5%) for step B, 720 (40.2%) for step C, 615 (34.3%) for step D, and 633 (35.3%) for step E. For angina with normal coronary arteries, rates of abnormal results were 81 (5.6%) for step A, 429 (29.9%) for step B, 432 (30.1%) for step C, 354 (24.6%) for step D, and 445 (31.0%) for step E. The dominant “solitary phenotype” was step B in 109 patients (9.1%). Conclusions: Stress-induced ischemia presents with a wide range of diagnostic phenotypes, highlighting its complex nature. Using a comprehensive approach such as the advanced ABCDE score, which combines multiple markers, proves to be more valuable than relying on a single marker in isolation.
AB - Background: Regional wall motion abnormality is considered a sensitive and specific marker of ischemia during stress echocardiography (SE). However, ischemia is a multifaceted entity associated with either coronary artery disease (CAD) or angina with normal coronary arteries, a distinction difficult to make using a single sign. The aim of this study was to evaluate the diagnostic potential of the five-step ABCDE SE protocol for CAD detection. Methods: From the 2016–2022 Stress Echo 2030 study data bank, 3,229 patients were selected (mean age, 66 ± 12 years; 2,089 men [65%]) with known CAD (n = 1,792) or angina with normal coronary arteries (n = 1,437). All patients were studied using both the ABCDE SE protocol and coronary angiography, within 3 months. In step A, regional wall motion abnormality is assessed; in step B, B-lines and diastolic function; in step C, left ventricular contractile reserve; in step D, coronary flow velocity reserve in the left anterior descending coronary artery; and in step E, heart rate reserve. Results: SE response ranged from a score of 0 (all steps normal) to a score of 5 (all steps abnormal). For CAD, rates of abnormal results were 347 for step A (19.4%), 547 (30.5%) for step B, 720 (40.2%) for step C, 615 (34.3%) for step D, and 633 (35.3%) for step E. For angina with normal coronary arteries, rates of abnormal results were 81 (5.6%) for step A, 429 (29.9%) for step B, 432 (30.1%) for step C, 354 (24.6%) for step D, and 445 (31.0%) for step E. The dominant “solitary phenotype” was step B in 109 patients (9.1%). Conclusions: Stress-induced ischemia presents with a wide range of diagnostic phenotypes, highlighting its complex nature. Using a comprehensive approach such as the advanced ABCDE score, which combines multiple markers, proves to be more valuable than relying on a single marker in isolation.
KW - Echocardiography
KW - Ischemic cascade
KW - Myocardial ischemia
KW - Stress
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U2 - 10.1016/j.echo.2023.12.003
DO - 10.1016/j.echo.2023.12.003
M3 - Article
C2 - 38092306
AN - SCOPUS:85182349473
SN - 0894-7317
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
ER -