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ABCDE vasodilator stress echocardiography in non-ischemic heart failure

Session Stress echocardiography in 2020

Speaker Natalia Kuznetsova

Event : EuroEcho 2019

  • Topic : imaging
  • Sub-topic : Stress Echocardiography
  • Session type : Rapid Fire Abstracts

Authors : N Kuznetsova (moscow,RU), C Borguezan Daros (Criciuma,BR), H Zanella (Mexico City,MX), Q Ciampi (Benevento,IT), L Cortigiani (Lucca,IT), N Gaibazzi (Parma,IT), A Zagatina (Saint Petersburg,RU), JL De Castro E Silva Pretto (Passo Fundo,BR), A Djordjevic-Dikic (Belgrade,RS), I Simova (Sofia,BG), M Amor (buenos aires,AR), PM Merlo (buenos aires,AR), J Lowenstein (buenos aires,AR), MAR Torres (Porto Alegre,BR), E Picano (Pisa,IT)

N Kuznetsova1 , C Borguezan Daros2 , H Zanella3 , Q Ciampi4 , L Cortigiani5 , N Gaibazzi6 , A Zagatina7 , JL De Castro E Silva Pretto8 , A Djordjevic-Dikic9 , I Simova10 , M Amor11 , PM Merlo12 , J Lowenstein12 , MAR Torres13 , E Picano14 , 1Moscow University Medical School, Cardiology - moscow - Russian Federation , 2Hospital San Josè, Cardiology - Criciuma - Brazil , 3National Institute of Cardiology Ignacio Chavez, Cardiology - Mexico City - Mexico , 4Fatebenefratelli Hospital, Division of Cardiology - Benevento - Italy , 5San Luca Hospital, Cardiology - Lucca - Italy , 6University Hospital of Parma, Cardiology - Parma - Italy , 7Saint Petersburg Pavlov State Medical University, Cardiology - Saint Petersburg - Russian Federation , 8Hospital Sao Vicente, Cardiology - Passo Fundo - Brazil , 9Clinical center of Serbia, Cardiology - Belgrade - Serbia , 10City Clinic, Cardiology - Sofia - Bulgaria , 11Ramos Mejia Hospital, Cardiology - buenos aires - Argentina , 12Cardiodiagnosticos, Investigaciones Medicas, Cardiology - buenos aires - Argentina , 13Federal University of Rio Grande do Sul, Cardiology - Porto Alegre - Brazil , 14Institute of Clinical Physiology, CNR, Biomedicine Department - Pisa - Italy ,

On behalf: Stress Echo 2020 study group of the Italian Society of Cardiovascular Imaging

Stress Echocardiography

Background:  ABCDE-stress echocardiography (SE) may explore different aspects in the heterogeneous  entity of known or suspected heart failure (HF).
Aim: To assess ABCDE-vasodilator SE in non-ischemic  HF
Methods: In a prospective, observational, multicenter study, we recruited 428 patients with angiographically normal coronary arteries: 148 patients with  HF and preserved (>50%) ejection fraction (HFpEF, Group 1); 100 with HF and mid-range (40-50%) ejection fraction (HFmrEF, Group 2); 180 with HF and reduced (<40%) ejection fraction (HFrEF, Group 3). A group of 75 healthy asymptomatic patients (30 male, 40%, age 57±14 years) referred to testing for screening  was also selected (Controls). All patients underwent vasodilator SE with dipyridamole (0.84 mg/kg) in 14 accredited laboratories of 5 countries (Argentina, Brasil, Russian Federation, Serbia and Italy). The ABCDE-SE protocol was adopted: A for regional wall motion abnormalities; B for B-lines (positivity criterion: stress = rest for = 2 points in a 4-site simplified scan available in 181 pts and 10 controls); C for left ventricular contractile reserve (LVCR) based on force (systolic blood pressure/end-systolic volume, positivity criterion: peak/ rest =1.1); D for pulsed wave Doppler-based assessment of coronary flow velocity reserve (CFVR) in left anterior descending coronary artery (positivity criterion: peak/rest =2.0); E for EKG-based assessment of heart rate reserve (positivity criterion: peak/rest =1.22).
Results: All positivity criteria, except A,  were more prevalent (p<.01) in Group 3 compared to Group 2, in Group 2 compared to Group 1, and Group 1 compared  to controls: see figure.  In particular, a blunted heart rate reserve was found in 4/75 controls (5%), 27/148 pts of Group 1 (18%), 28/100 of Group 2 (28%) and 98/180 of Group 3 (54%).
Conclusions: ABCDE-vasodilator SE can help to identify the profound pathophysiological heterogeneity underlying a similar  clinical presentation in patients with known or suspected HF with angiographically normal coronary arteries. These patients rarely show stress-induced regional wall motion abnormalities (A), but may exhibit pulmonary congestion (B), reduced myocardial functional reserve (C), altered coronary microcirculation (D) and cardiac autonomic dysfunction (E).

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