Prognostic value of stress echocardiography assessed by the ABCDE protocol

Aim The aim of this study was to assess the prognostic value of ABCDE-SE in a prospective, large scale, multicentre, international, effectiveness study. Stress echocardiography (SE) was recently upgraded to the ABCDE protocol: step A, regional wall motion abnormalities; step B, B lines; step C, left ventricular contractile reserve; step D, Doppler-based coronary flow velocity reserve in left anterior descending coronary artery; and step E, electrocardiogram-based heart rate reserve. Methods and results From July 2016 to November 2020, we enrolled 3574 all-corners (age 65 +/- 11 years, 2070 males, 58%; ejection fraction 60 +/- 10%) with known or suspected chronic coronary syndromes referred from 13 certified laboratories. All patients underwent clinically indicated ABCDE-SE. The employed stress modality was exercise (n=952, with semi-supine bike, n= 887, or treadmill, n= 65 with adenosine for step D) or pharmacological stress (n = 2622, with vasodilator, n= 2151; or dobutamine, n=471). SE response ranged from score 0 (all steps normal) to score 5 (all steps abnormal). All-cause death was the only endpoint. Rate of abnormal results was 16% for A, 30% for B, 36% for C, 28% for D, and 37% for E steps. During a median follow-up of 21 months (interquartile range: 13-36), 73 deaths occurred. Global X-2 was 49.5 considering clinical variables, 50.7 after step A only (P = NS (not significant)) and 80.6 after B-E steps (P < 0.001 vs. step A). Annual mortality rate ranged from 0.4% person-year for score 0 up to 2.7% person-year for score 5. Conclusion ABCDE-SE allows an effective prediction of survival in patients with chronic coronary syndromes. [GRAPHICS] .

Automated summary

The study aimed to assess the prognostic value of ABCDE-SE in patients with chronic coronary syndromes, showing that it effectively predicts survival in this patient population. Abnormal results were found in different steps of the ABCDE protocol, with annual mortality rates varying based on the score received.