Multiple Phenotypes of Chronic Coronary Syndromes Identified by ABCDE Stress Echocardiography - 02/05/24
, Quirino Ciampi, MD b, Lauro Cortigiani, MD c, Karina Wierzbowska-Drabik, MD d, Angela Zagatina, MD e, Ana Djordjevic-Dikic, MD f, Fiore Manganelli, MD g, Alla Boshchenko, MD h, Clarissa Borguezan-Daros, MD i, Rosina Arbucci, MD j, Sofia Marconi, MD j, Jorge Lowenstein, MD j, Maciej Haberka, MD k, Jelena Celutkiene, MD l, Antonello D’Andrea, MD m, Hugo Rodriguez-Zanella, MD n, Fausto Rigo, MD o, Ines Monte, MD p, Marco Fabio Costantino, MD q, Miodrag Ostojic, MD r, Elisa Merli, MD s, Mauro Pepi, MD t, Scipione Carerj, MD u, Jaroslaw D. Kasprzak, MD v, Patricia A. Pellikka, MD w, Eugenio Picano, MD xon Behalf of the
Stress Echo 2030 Study Group
Abstract |
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.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Potential utility of GLS in AS.
Multiple phenotypes of myocardial ischemia markers identified on ABCDE SE and their differences between patients with CAD and those with ANOCA. CCTA, Coronary computed tomographic angiography; ECG, electrocardiographic.
Central IllustrationMultiple phenotypes of myocardial ischemia markers identified on ABCDE SE and their differences between patients with CAD and those with ANOCA. CCTA, Coronary computed tomographic angiography; ECG, electrocardiographic.Le texte complet de cet article est disponible en PDF.
Highlights |
• | Stress-induced ischemia is characterized by multiplicity of diagnostic phenotypes. |
• | Coronary artery disease and ANOCA show different stress echocardiography responses. |
• | Markers combined with ABCDE score are more useful than any single marker alone. |
Keywords : Echocardiography, Ischemic cascade, Myocardial ischemia, Stress
Abbreviations : ANOCA, CAD, CFVR, HRR, LAD, LV, LVCR, RWMA, SE, SIECVI
Plan
| Natesa G. Pandian, MD, served as guest editor for this report. |
Vol 37 - N° 5
P. 477-485 - mai 2024 Retour au numéro
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