Exercise stress echocardiography with ABCDE protocol in unexplained dyspnoea.

Area of Science:

• Cardiology
• Diagnostic Imaging
• Pulmonology

Background:

• Current guidelines recommend exercise stress echocardiography (ESE) for unexplained dyspnoea.
• The ABCDE protocol (Asynergy, B-lines, Contractile reserve, Coronary flow velocity reserve, Heart rate reserve) enhances SE evaluation.

Purpose of the Study:

• To define the ESE response in patients presenting with dyspnoea as their primary symptom.
• To compare ESE findings between patients with dyspnoea and those with chest pain.

Main Methods:

• 100 patients with dyspnoea (Group 1) and 100 with chest pain (Group 2) underwent ESE with the ABCDE protocol.
• Exclusion criteria included prior myocardial infarction or coronary revascularization.
• Success rates for protocol steps A, B, C, E were 100%, and step D was 88%.

Main Results:

• Group 1 (dyspnoea) showed significantly higher positivity for Asynergy (A), LV Contractile Reserve (LVCR), reduced Coronary Flow Velocity Reserve (CFVR), and blunted Heart Rate Reserve (HRR) compared to Group 2 (chest pain).
• B-lines positivity showed a non-significant trend towards higher rates in Group 1.
• Positivity rates: A (p<0.0001), LVCR (p<0.05), CFVR (p<0.0001), HRR (p<0.001).

Conclusions:

• The ABCDE protocol is valuable for diagnosing cardiac causes of dyspnoea.
• ESE provides a comprehensive assessment, evaluating ischemia, pulmonary congestion, myocardial scar/necrosis, microvascular dysfunction, and chronotropic incompetence.