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ABCDE Protocol for Stress Echocardiography in Chronic Coronary Syndromes

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Abstract

Five parameters converge conceptually, logistically, and methodologically in the ABCDE protocol of stress echocardiography, assessing the many vulnerabilities of the patient above and beyond the critical coronary artery stenosis: (1) step A: regional wall motion by 2-dimensional echocardiography; (2) step B: B-lines by lung ultrasound (with the 4-site simplified scan of third intercostal space) assessing pulmonary congestion; (3) step C: left ventricular contractile reserve assessed as the stress/rest ratio of force (systolic arterial pressure by cuff sphygmomanometer/end-systolic volume from 2D) or more simply as left ventricular cavity dilation during stress; (4) step D: Doppler-based assessment of coronary flow velocity reserve in left anterior descending coronary with pulsed-wave Doppler; and (5) step E: imaging-independent EKG-based assessment of heart rate reserve (peak/rest heart rate). The same transducer is used for cardiac and lung scans. The cutoff values are stress-independent for A, C, and D, but stress-specific for C and E, since vasodilators are a weaker inotropic and chronotropic stress than exercise and dobutamine. The combination of these five parameters in a single test allows more comprehensive risk stratification than regional wall motion alone since each parameter provides independent and incremental value in predicting outcome even when only survival is considered.

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Ciampi, Q., Picano, E. (2023). ABCDE Protocol for Stress Echocardiography in Chronic Coronary Syndromes. In: Picano, E. (eds) Stress Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-031-31062-1_11

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  • DOI: https://doi.org/10.1007/978-3-031-31062-1_11

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