Prognostic value of stress echocardiography assessed by the ABCDE protocol

Area of Science:

• Cardiology
• Echocardiography
• Diagnostic Imaging

Background:

• Chronic coronary syndromes (CCS) require accurate prognostic assessment for optimal patient management.
• Stress echocardiography (SE) is a key diagnostic tool in evaluating patients with suspected or known CCS.
• The ABCDE protocol represents an updated, comprehensive approach to SE.

Purpose of the Study:

• To evaluate the prognostic capability of the ABCDE-SE protocol in a large, international cohort of patients with CCS.
• To determine if the ABCDE-SE score predicts all-cause mortality in this patient population.
• To assess the incremental prognostic value of different components of the ABCDE-SE protocol.

Main Methods:

• A prospective, multicenter, international effectiveness study enrolled 3574 patients with CCS.
• Patients underwent clinically indicated ABCDE-SE using exercise or pharmacological stress.
• The ABCDE-SE protocol assesses regional wall motion, B lines, left ventricular contractile reserve, coronary flow velocity reserve, and heart rate reserve.

Main Results:

• Abnormal results were observed in 16% (A) to 37% (E) of the assessed steps.
• Over a median follow-up of 21 months, 73 deaths occurred.
• The ABCDE-SE score demonstrated significant prognostic value (Global X2=80.6, P<0.001) for mortality, with annual rates increasing from 0.4% to 2.7% for scores 0 to 5, respectively.

Conclusions:

• The ABCDE-SE protocol is an effective tool for predicting survival in patients with chronic coronary syndromes.
• The comprehensive assessment provided by the ABCDE-SE protocol offers significant prognostic information beyond clinical variables alone.
• This study validates the utility of the updated ABCDE-SE protocol in a large, real-world patient cohort.