In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

Member Benefit

This content is only available year-round to EACVI Silver Members, Fellows of the ESC and Young combined Members

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)

Authors:
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

Topic(s):
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).

Member Benefit

This content is only available year-round to EACVI Silver Members, Fellows of the ESC and Young combined Members

Get your access to resources

Join now
  • 1ESC Professional Members – access all ESC Congress resources 
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s resources
  • 3Under 40 or in training - with a Combined Membership, access all resources
Join now
logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are