1. Prognostic value of stress echocardiography assessed by the ABCDE protocol
- Author
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Karina Wierzbowska-Drabik, Jarosław D. Kasprzak, Angela Zagatina, Costantina Prota, Tamara Ryabova, Martina Samardjieva, Eugenio Picano, Fausto Rigo, Alla A. Boshchenko, Maciej Haberka, Iana Simova, Patricia A. Pellikka, Doralisa Morrone, Clara Carpeggiani, Andrea Barbieri, Nicola Gaibazzi, Lauro Cortigiani, Valentina Lorenzoni, Claudio Dodi, Francesco Antonini-Canterin, Mauro Pepi, Branko Beleslin, Bruno Villari, Quirino Ciampi, and Ana Djordjevic-Dikic
- Subjects
Male ,medicine.medical_specialty ,Supine position ,Myocardial Ischemia ,Vulnerability ,Ischaemic Heart Disease ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Anterior Descending Coronary Artery ,Stress ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Clinical Research ,Interquartile range ,Dobutamine ,Internal medicine ,0502 economics and business ,Heart rate ,Stress Echocardiography ,Humans ,Medicine ,AcademicSubjects/MED00200 ,Prospective Studies ,Outcome ,Aged ,Ejection fraction ,business.industry ,Mortality rate ,05 social sciences ,Middle Aged ,Prognosis ,Coronary Vessels ,Echocardiography ,Echocardiography, Stress ,3. Good health ,Cardiology ,050211 marketing ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Aim The aim of this study was to assess the prognostic value of ABCDE-SE in a prospective, large scale, multicentre, international, effectiveness study. Stress echocardiography (SE) was recently upgraded to the ABCDE protocol: step A, regional wall motion abnormalities; step B, B lines; step C, left ventricular contractile reserve; step D, Doppler-based coronary flow velocity reserve in left anterior descending coronary artery; and step E, electrocardiogram-based heart rate reserve. Methods and results From July 2016 to November 2020, we enrolled 3574 all-comers (age 65 ± 11 years, 2070 males, 58%; ejection fraction 60 ± 10%) with known or suspected chronic coronary syndromes referred from 13 certified laboratories. All patients underwent clinically indicated ABCDE-SE. The employed stress modality was exercise (n = 952, with semi-supine bike, n = 887, or treadmill, n = 65 with adenosine for step D) or pharmacological stress (n = 2622, with vasodilator, n = 2151; or dobutamine, n = 471). SE response ranged from score 0 (all steps normal) to score 5 (all steps abnormal). All-cause death was the only endpoint. Rate of abnormal results was 16% for A, 30% for B, 36% for C, 28% for D, and 37% for E steps. During a median follow-up of 21 months (interquartile range: 13–36), 73 deaths occurred. Global X2 was 49.5 considering clinical variables, 50.7 after step A only (P = NS (not significant)) and 80.6 after B–E steps (P, Graphical Abstract This study recruited 3,574 patients from 13 stress echo laboratories of 5 countries and shows the prognostic value of the new state-of-the art cardiac functional testing with stress echo ABCDE protocol: Step A for regional wall motion abnormalities; step B for B-lines obtained with 4-site simplified scan and lung ultrasound; step C for contractile reserve with volumetric echocardiography; step D for Doppler-based assessment of coronary flow reserve in mid-distal left anterior descending coronary artery; step E for EKG-based heart rate reserve.
- Published
- 2021
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