Prognostic value of multi-marker stress echocardiography

Area of Science:

• Cardiology
• Diagnostic Imaging
• Echocardiography

Background:

• Traditional stress echocardiography (SE) primarily detects coronary artery disease (CAD) using regional wall motion abnormalities (RWMA).
• This single-marker approach shows declining positivity and prognostic utility in current patient populations.
• SE has transformed into a multi-marker assessment of patient vulnerability.

Purpose of the Study:

• To introduce and detail the ABCDE-SE protocol, a comprehensive, multi-marker approach to stress echocardiography.
• To demonstrate how the ABCDE-SE protocol refines risk stratification and enables personalized cardiovascular medicine.

Main Methods:

• The ABCDE-SE protocol integrates five sequential steps during a single stress test: RWMA (A), pulmonary congestion (B), left ventricular volume (C), microvascular function (D), and autonomic function (E).
• The protocol was developed and validated through the SE 2030 study (2016-2030), involving 50 international laboratories.
• Each step targets distinct pathophysiological mechanisms and therapeutic targets.

Main Results:

• The ABCDE-SE protocol provides a comprehensive functional assessment, moving beyond traditional CAD detection.
• It significantly refines risk stratification by evaluating multiple pathophysiological mechanisms.
• The protocol is universally applicable to patients with suspected cardiac disease.

Conclusions:

• The ABCDE-SE protocol represents a paradigm shift in stress echocardiography, offering a multi-marker, comprehensive assessment.
• This approach facilitates personalized medicine by identifying specific patient vulnerabilities for tailored therapies.
• The protocol is a widely accessible platform for improved cardiovascular risk assessment and management.