ABCDE stress echocardiography parameters in predicting immediate cardiovascular events in patients with confirmed and suspected coronary artery disease
https://doi.org/10.15829/1728-8800-2025-4489
EDN: WATKON
Abstract
Aim. To assess the role of stress echocardiography (SE) parameters according to ABCDE protocol as predictors of cardiovascular events (CVD).
Material and methods. This single-center prospective study included 253 patients (men n=130, 51,4%; median age, 62 (53; 68) years) with confirmed (14,2%) and suspected coronary artery disease (CAD). Exercise SE was performed according to clinical indications. The ABCDE protocol included assessment of regional wall motion (step A), B-lines (step B), contractile (step C), coronary (step D), chronotropic (step E) reserves of the left ventricle. The median follow-up period was 198 (118; 324) days. Twenty one (8,3%) patients underwent revascularization, while 11 patients (4,4%) were rehospitalized for cardiovascular events. The influence of clinical and echocardiographic parameters on endpoints was assessed.
Results. The incidence of abnormal SE results was 8,7% (n=22) for step A, 10,7% (n=27) for step B, 63,6% (n=161) for step C, 47,4% n=120) for step D, and 35,6% (n=90) for step E. An independent predictor of readmission was the ACDE profile (a combination of positive SE steps) (odds ratio, OR 22,4; p=0,003); predictors of revascularization were the ABCDE score (OR 24,4; p=0,005), chest pain pattern (OR 7,2; p=0,005), DE profile (OR 762; p=0,003), chronotropic reserve (OR 437; p=0,019), number of risk factors (OR 7,7; p=0,009).
Conclusion. ABCDE protocol SE allows for a comprehensive assessment of heart functional status, improves the diagnostic ability of stress test, and identifies predictors of cardiovascular disease in patients with suspected and confirmed CAD.
About the Authors
T. M. Timofeeva
Peoples' Friendship University of Russia
Russian Federation
Russian Federation
Moscow
A. F. Safarova
Peoples' Friendship University of Russia
Russian Federation
Russian Federation
Moscow
Zh. D. Kobalava
Peoples' Friendship University of Russia
Russian Federation
Russian Federation
Moscow
V. P. Efimova
Peoples' Friendship University of Russia
Russian Federation
Russian Federation
Moscow
References
1. Sanchis-Gomar F, Perez-Quilis C, Leischik R, et al. Epidemiology of coronary heart disease and acute coronary syndrome. Ann Transl Med. 2016;4(13):256. doi:10.21037/atm.2016.06.33.
2. Barbarash OL, Karpov YuA, Panov AV, et al. 2024 Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology. 2024;29(9):6110. (In Russ.) doi:10.15829/1560-4071-2024-6110.
3. Mehta P, McDonald S, Hirani R, et al. Major adverse cardiac events after emergency department evaluation of chest pain patients with advanced testing: Systematic review and meta-analysis. Acad Emerg Med. 2022;29(6):748-64. doi:10.1111/acem.14407.
4. Gaibazzi N, Ciampi Q, Cortigiani L, et al.; Stress Echo 2030 Study Group. Multiple phenotypes of chronic coronary syndromes identified by ABCDE Stress Echocardiography. J Am Soc Echocardiogr. 2024;37(5):477-85. doi:10.1016/j.echo.2023.12.003.
5. Stress echocardiography. Picano E, ed. 6th ed. Heidelberg: Springer Verlag; 2015. ISBN: 978-3-031-31061-4. doi:10.1007/978-3-031-31062-1.
6. Pellikka PA, Arruda-Olson A, Chaudhry FA, et al. Guidelines for performance, interpretation, and application of stress echocardiography in ischemic heart disease: from the American Society of echocardiography. J Am Soc Echocardiogr. 2020;33(1):1-41.e8. doi:10.1016/j.echo.2019.07.001.
7. Zhuravleva OA, Ryabova TR, Vrublevsky AV, et al. Stress Echocardiography by the ABCDE Protocol ln the Assessment of Prognosis of Stable Coronary Heart Disease. Kardiologiia. 2024;64(4):22-30. (In Russ.) doi:10.18087/cardio.2024.4.n2572.
8. Diamond GA. A clinically relevant classification of chest discomfort. J Am Coll Cardiol. 1983;1(2 Pt 1):574-5. doi:10.1016/s0735-1097(83)80093-x.
9. Vrints C, Andreotti F, Koskinas KC, et al.; ESC Scientific Document Group. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45(36):3415-537. doi:10.1093/eurheartj/ehae177.
10. Evangelista A, Flachskampf F, Lancellotti P, et al.; European Association of Echocardiography. European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr. 2008;9(4):438-48. doi:10.1093/ejechocard/jen174.
11. Matskeplishvili ST, Saidova MA, Mironenko Myu, et al. Standard transthoracic echocardiography. Guidelines 2024. Russian Journal of Cardiology. 2025;30(2):6271. (In Russ.) doi:10.15829/1560-4071-2025-6271.
12. Ciampi Q, Zagatina A, Cortigiani L, et al. Prognostic value of stress echocardiography assessed by the ABCDE protocol. Eur Heart J. 2021;42(37):3869-78. doi:10.1093/eurheartj/ehab493.
13. Cortigiani L, Ramirez P, Coltelli M, et al. Drop-off in positivity rate of stress echocardiography based on regional wall motion abnormalities over the last three decades. Int J Cardiovasc Imaging. 2019; 35(4):627-32. doi:10.1007/s10554-018-1501-3.
14. Kotovskaya YuV, Tkacheva ON, Runikhina NK, et al. Physical activity as a means of preventing cardiovascular diseases in elderly patients Doctor.Ru. 2019;2(157):19-22. (In Russ.) doi:10.31550/1727-2378-2019-157-2-19-22.
15. Dydyshko VT, Naumkina PI, Barsukov AV. Predictors of low tolerance to physical activity in young and middle-aged men. Physical and Rehabilitation Medicine. 2024;6(2):12-26. (In Russ.) doi:10.26211/2658-4522-2024-6-2-12-26.
16. Sicari R, Cortigiani L. The clinical use of stress echocardiography in ischemic heart disease. Cardiovasc Ultrasound. 2017;15(1):7. doi:10.1186/s12947-017-0099-2.
17. Ciampi Q, Zagatina A, Cortigiani L, et al. Functional, anatomical, and prognostic correlates of coronary flow velocity reserve during stress echocardiography. J Am Coll Cardiol. 2019;74(18):2278-91. doi:10.1016/j.jacc.2019.08.1046.
18. Timofeeva TM, Safarova AF, Pavlikov GS, et al. Clinical and diagnostic value of ABCDE stress echocardiography with exercise in patients with myocardial infarction. Kardiologiia. 2024;64(12):35- 43. (In Russ.) doi:10.18087/cardio.2024.12.n2751.
19. Yarmedova SF, Yavelov IS, Drapkina OM. Myocardial ischemia as a cause of paroxysmal dyspnea in patients with stable coronary artery disease. Cardiovascular Therapy and Prevention. 2024; 23(12):4267. (In Russ.) doi:10.15829/1728-8800-2024-4267.
20. Kozlov SG, Chernova OV, Shitov VN, et al. Stress echocardiography vs coronary computed tomography angiography for the detection of obstructive coronary artery disease in patients aged >70 years with suspected stable coronary artery disease. Cardiovascular Therapy and Prevention. 2020;19(5):2374. (In Russ.) doi:10.15829/1728-8800-2020-2374.
21. Koretsky SN, Mirgorodskaya OV, Vasyuk YuA, et al. Diagnostic significance of myocardial and multimodal contrast exercise stress echocardiography in the detection of hemodynamically significant coronary artery stenosis in stable angina pectoris. Cardiovascular Therapy and Prevention. 2023;22(4):3540. (In Russ.) doi:10.15829/1728-8800-2023-3540.
22. Bombardini T, Zagatina A, Ciampi Q, et al. Stress Echo 2020 Study Group of the Italian Society of Echocardiography and Cardiovascular Imaging. Feasibility and value of two-dimensional volumetric stress echocardiography. Minerva Cardiol Angiol. 2022;70(2):148-59. doi:10.23736/S2724-5683.20.05304-9.
23. Brubaker PH, Kitzman DW. Chronotropic incompetence: causes, consequences, and management. Circulation. 2011;123(9):1010- 20. doi:10.1161/CIRCULATIONAHA.110.940577.
24. Picano E, Ciampi Q, Arbucci R, et al. Stress Echo 2030: the new ABCDE protocol defining the future of cardiac imaging. Eur Heart J Suppl. 2023;25(Suppl C):C63-7. doi:10.1093/eurheartjsupp/suad008.
Supplementary files
What is already known about the subject?
- Stress echocardiography (SE) is indicated for the diagnosis of coronary artery disease with a high recommendation class.
- The multi-stage ABCDE protocol can provide important additional information.
What might this study add?
- The use of ABCDE-SE protocol with exercise allows risk stratification of patients with confirmed and suspected coronary artery disease.
- Additional parameters of ABCDE SE protocol can improve the diagnostic value of exercise testing.
Review
For citations:
Timofeeva T.M., Safarova A.F., Kobalava Zh.D., Efimova V.P. ABCDE stress echocardiography parameters in predicting immediate cardiovascular events in patients with confirmed and suspected coronary artery disease. Cardiovascular Therapy and Prevention. 2025;24(8):4489. (In Russ.) https://doi.org/10.15829/1728-8800-2025-4489. EDN: WATKON
Views:
500
Email this article 
