Multiple Phenotypes of Chronic Coronary Syndromes Identified by ABCDE Stress Echocardiography

Area of Science:

• Cardiology
• Diagnostic Imaging
• Echocardiography

Background:

• Regional wall motion abnormality is a key marker for ischemia in stress echocardiography (SE).
• Ischemia is complex, presenting challenges in distinguishing coronary artery disease (CAD) from angina with normal coronary arteries using single indicators.
• The study aimed to assess the diagnostic utility of the five-step ABCDE SE protocol for detecting CAD.

Purpose of the Study:

• To evaluate the diagnostic potential of the five-step ABCDE SE protocol for coronary artery disease (CAD) detection.
• To explore the multifaceted nature of ischemia and its various diagnostic phenotypes.
• To compare the effectiveness of a comprehensive multi-marker approach versus single markers in SE.

Main Methods:

• Analysis of data from 3,229 patients (2016-2022) with known CAD or angina with normal coronary arteries.
• All patients underwent both the ABCDE SE protocol and coronary angiography within three months.
• The ABCDE protocol assesses: A-regional wall motion, B-B-lines/diastolic function, C-left ventricular contractile reserve, D-coronary flow velocity reserve, and E-heart rate reserve.

Main Results:

• Abnormal results varied across the five steps (A-E) for both CAD and angina groups.
• For CAD, abnormal rates ranged from 19.4% (Step A) to 40.2% (Step C).
• For angina with normal coronary arteries, abnormal rates ranged from 5.6% (Step A) to 31.0% (Step E), with Step B being the dominant solitary phenotype in 9.1% of patients.

Conclusions:

• Stress-induced ischemia exhibits diverse diagnostic phenotypes, underscoring its complexity.
• A comprehensive approach, like the ABCDE score combining multiple markers, is more valuable than isolated single markers for diagnosing ischemia.
• The ABCDE protocol provides a more robust assessment of ischemia compared to relying on individual stress echocardiography findings.