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Exercise stress echocardiography with ABCDE protocol in unexplained dyspnoea. / Stress Echo 2020 study group of the Italian Society of Cardiovascular Echography.
In: International Journal of Cardiovascular Imaging, Vol. 36, No. 5, 05.2020, p. 823-831.Research output: Contribution to journal › Article › peer-review
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TY - JOUR
T1 - Exercise stress echocardiography with ABCDE protocol in unexplained dyspnoea
AU - Stress Echo 2020 study group of the Italian Society of Cardiovascular Echography
AU - Zagatina, Angela
AU - Zhuravskaya, Nadezhda
AU - Shmatov, Dmitry
AU - Ciampi, Quirino
AU - Carpeggiani, Clara
AU - Picano, Eugenio
PY - 2020/5
Y1 - 2020/5
N2 - Current guidelines recommend the use of exercise stress echocardiography (ESE) in patients with unexplained dyspnoea. SE was recently reshaped with the ABCDE protocol: A for asynergy, B for B-lines (4-site simplified scan), C for contractile reserve based on force, D for Doppler-based coronary flow velocity reserve (CFVR) in left anterior descending coronary artery; and E for EKG-based heart rate reserve (HRR, defined as peak/rest HR < 1.62). Aim of the study was to define the ESE response in patients with dyspnoea as the main symptom. From the initial population of patients referred in 2018 in a single center for semi-supine ESE, we selected two groups (without history of previous myocardial infarction or coronary revascularization) on the basis of the main presenting symptom: dyspnoea (Group 1, n = 100, 62 men, 63 ± 10 years) or chest pain (Group 2, n = 100, 58 men, age 61 ± 8 years). All underwent ESE with ABCDE protocol. Success rate was 100% for steps A, B, C, E, and 88% for step D. Positivity for A criterion occurred in 56 patients of Group 1 and 24 of Group 2 (p < 0.0001). B-lines positivity (stress > rest for ≥ 2 points) occurred in 40 patients of Group 1 and 28 of Group 2 (p = 0.07). LVCR positivity (< 2.0) occurred in 60 patients of Group 1 and 42 of Group 2 (p < 0.05). A reduced CFVR occurred in 56 of Group 1 and 22 of Group 2 (p < 0.0001). A blunted HRR was present in 44 patients of Group 1 and 22 of Group 2 (p < 0.001). In conclusion, in patients with unexplained dyspnoea, SE with ABCDE protocol is useful to document the cardiac origin of dyspnoea with a comprehensive assessment focused not only on ischemia (A) but also pulmonary congestion (B), myocardial scar or necrosis (C), coronary microvascular dysfunction (D) or chronotropic incompetence (E).
AB - Current guidelines recommend the use of exercise stress echocardiography (ESE) in patients with unexplained dyspnoea. SE was recently reshaped with the ABCDE protocol: A for asynergy, B for B-lines (4-site simplified scan), C for contractile reserve based on force, D for Doppler-based coronary flow velocity reserve (CFVR) in left anterior descending coronary artery; and E for EKG-based heart rate reserve (HRR, defined as peak/rest HR < 1.62). Aim of the study was to define the ESE response in patients with dyspnoea as the main symptom. From the initial population of patients referred in 2018 in a single center for semi-supine ESE, we selected two groups (without history of previous myocardial infarction or coronary revascularization) on the basis of the main presenting symptom: dyspnoea (Group 1, n = 100, 62 men, 63 ± 10 years) or chest pain (Group 2, n = 100, 58 men, age 61 ± 8 years). All underwent ESE with ABCDE protocol. Success rate was 100% for steps A, B, C, E, and 88% for step D. Positivity for A criterion occurred in 56 patients of Group 1 and 24 of Group 2 (p < 0.0001). B-lines positivity (stress > rest for ≥ 2 points) occurred in 40 patients of Group 1 and 28 of Group 2 (p = 0.07). LVCR positivity (< 2.0) occurred in 60 patients of Group 1 and 42 of Group 2 (p < 0.05). A reduced CFVR occurred in 56 of Group 1 and 22 of Group 2 (p < 0.0001). A blunted HRR was present in 44 patients of Group 1 and 22 of Group 2 (p < 0.001). In conclusion, in patients with unexplained dyspnoea, SE with ABCDE protocol is useful to document the cardiac origin of dyspnoea with a comprehensive assessment focused not only on ischemia (A) but also pulmonary congestion (B), myocardial scar or necrosis (C), coronary microvascular dysfunction (D) or chronotropic incompetence (E).
KW - Coronary flow velocity reserve
KW - Heart failure
KW - Stress echocardiography
KW - Coronary Circulation
KW - Dyspnea/etiology
KW - Myocardial Contraction
KW - Heart Rate
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Ventricular Function, Left
KW - Heart Diseases/complications
KW - Humans
KW - Middle Aged
KW - Risk Factors
KW - Male
KW - Echocardiography, Doppler, Color
KW - Echocardiography, Doppler, Pulsed
KW - Exercise Test
KW - Echocardiography, Stress/methods
KW - Blood Flow Velocity
KW - Electrocardiography
KW - Female
KW - Aged
KW - VELOCITY RESERVE
KW - EUROPEAN ASSOCIATION
KW - RECOMMENDATIONS
KW - CORONARY FLOW
KW - CHRONOTROPIC INCOMPETENCE
KW - HEART-RATE RESPONSE
KW - AMERICAN SOCIETY
UR - http://www.scopus.com/inward/record.url?scp=85079211171&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/1c6b680b-0c83-384b-9d83-82ce8d598266/
U2 - 10.1007/s10554-020-01789-6
DO - 10.1007/s10554-020-01789-6
M3 - Article
C2 - 32036487
AN - SCOPUS:85079211171
VL - 36
SP - 823
EP - 831
JO - International Journal of Cardiovascular Imaging
JF - International Journal of Cardiovascular Imaging
SN - 1569-5794
IS - 5
ER -
ID: 53113255