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The new clinical standard of integrated quadruple stress echocardiography with ABCD protocol

BACKGROUND: The detection of regional wall motion abnormalities is the cornerstone of stress echocardiography. Today, stress echo shows increasing trends of utilization due to growing concerns for radiation risk, higher cost and stronger environmental impact of competing techniques. However, it has...

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Autores principales: Picano, Eugenio, Ciampi, Quirino, Wierzbowska-Drabik, Karina, Urluescu, Mădălina-Loredana, Morrone, Doralisa, Carpeggiani, Clara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167852/
https://www.ncbi.nlm.nih.gov/pubmed/30285774
http://dx.doi.org/10.1186/s12947-018-0141-z
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author Picano, Eugenio
Ciampi, Quirino
Wierzbowska-Drabik, Karina
Urluescu, Mădălina-Loredana
Morrone, Doralisa
Carpeggiani, Clara
author_facet Picano, Eugenio
Ciampi, Quirino
Wierzbowska-Drabik, Karina
Urluescu, Mădălina-Loredana
Morrone, Doralisa
Carpeggiani, Clara
author_sort Picano, Eugenio
collection PubMed
description BACKGROUND: The detection of regional wall motion abnormalities is the cornerstone of stress echocardiography. Today, stress echo shows increasing trends of utilization due to growing concerns for radiation risk, higher cost and stronger environmental impact of competing techniques. However, it has also limitations: underused ability to identify factors of clinical vulnerability outside coronary artery stenosis; operator-dependence; low positivity rate in contemporary populations; intermediate risk associated with a negative test; limited value of wall motion beyond coronary artery disease. Nevertheless, stress echo has potential to adapt to a changing environment and overcome its current limitations. INTEGRATED-QUADRUPLE STRESS-ECHO: Four parameters now converge conceptually, logistically, and methodologically in the Integrated Quadruple (IQ)-stress echo. They are: 1- regional wall motion abnormalities; 2-B-lines measured by lung ultrasound; 3-left ventricular contractile reserve assessed as the stress/rest ratio of force (systolic arterial pressure by cuff sphygmomanometer/end-systolic volume from 2D); 4- coronary flow velocity reserve on left anterior descending coronary artery (with color-Doppler guided pulsed wave Doppler). IQ-Stress echo allows a synoptic functional assessment of epicardial coronary artery stenosis (wall motion), lung water (B-lines), myocardial function (left ventricular contractile reserve) and coronary small vessels (coronary flow velocity reserve in mid or distal left anterior descending artery). In “ABCD” protocol, A stands for Asynergy (ischemic vs non-ischemic heart); B for B-lines (wet vs dry lung); C for Contractile reserve (weak vs strong heart); D for Doppler flowmetry (warm vs cold heart, since the hyperemic blood flow increases the local temperature of the myocardium). From the technical (acquisition/analysis) viewpoint and required training, B-lines are the kindergarten, left ventricular contractile reserve the primary (for acquisition) and secondary (for analysis) school, wall motion the university, and coronary flow velocity reserve the PhD program of stress echo. CONCLUSION: Stress echo is changing. As an old landline telephone with only one function, yesterday stress echo used one sign (regional wall motion abnormalities) for one patient with coronary artery disease. As a versatile smart-phone with multiple applications, stress echo today uses many signs for different pathophysiological and clinical targets. Large scale effectiveness studies are now in progress in the Stress Echo2020 project with the omnivorous “ABCD” protocol.
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spelling pubmed-61678522018-10-09 The new clinical standard of integrated quadruple stress echocardiography with ABCD protocol Picano, Eugenio Ciampi, Quirino Wierzbowska-Drabik, Karina Urluescu, Mădălina-Loredana Morrone, Doralisa Carpeggiani, Clara Cardiovasc Ultrasound Review BACKGROUND: The detection of regional wall motion abnormalities is the cornerstone of stress echocardiography. Today, stress echo shows increasing trends of utilization due to growing concerns for radiation risk, higher cost and stronger environmental impact of competing techniques. However, it has also limitations: underused ability to identify factors of clinical vulnerability outside coronary artery stenosis; operator-dependence; low positivity rate in contemporary populations; intermediate risk associated with a negative test; limited value of wall motion beyond coronary artery disease. Nevertheless, stress echo has potential to adapt to a changing environment and overcome its current limitations. INTEGRATED-QUADRUPLE STRESS-ECHO: Four parameters now converge conceptually, logistically, and methodologically in the Integrated Quadruple (IQ)-stress echo. They are: 1- regional wall motion abnormalities; 2-B-lines measured by lung ultrasound; 3-left ventricular contractile reserve assessed as the stress/rest ratio of force (systolic arterial pressure by cuff sphygmomanometer/end-systolic volume from 2D); 4- coronary flow velocity reserve on left anterior descending coronary artery (with color-Doppler guided pulsed wave Doppler). IQ-Stress echo allows a synoptic functional assessment of epicardial coronary artery stenosis (wall motion), lung water (B-lines), myocardial function (left ventricular contractile reserve) and coronary small vessels (coronary flow velocity reserve in mid or distal left anterior descending artery). In “ABCD” protocol, A stands for Asynergy (ischemic vs non-ischemic heart); B for B-lines (wet vs dry lung); C for Contractile reserve (weak vs strong heart); D for Doppler flowmetry (warm vs cold heart, since the hyperemic blood flow increases the local temperature of the myocardium). From the technical (acquisition/analysis) viewpoint and required training, B-lines are the kindergarten, left ventricular contractile reserve the primary (for acquisition) and secondary (for analysis) school, wall motion the university, and coronary flow velocity reserve the PhD program of stress echo. CONCLUSION: Stress echo is changing. As an old landline telephone with only one function, yesterday stress echo used one sign (regional wall motion abnormalities) for one patient with coronary artery disease. As a versatile smart-phone with multiple applications, stress echo today uses many signs for different pathophysiological and clinical targets. Large scale effectiveness studies are now in progress in the Stress Echo2020 project with the omnivorous “ABCD” protocol. BioMed Central 2018-10-02 /pmc/articles/PMC6167852/ /pubmed/30285774 http://dx.doi.org/10.1186/s12947-018-0141-z Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Review
Picano, Eugenio
Ciampi, Quirino
Wierzbowska-Drabik, Karina
Urluescu, Mădălina-Loredana
Morrone, Doralisa
Carpeggiani, Clara
The new clinical standard of integrated quadruple stress echocardiography with ABCD protocol
title The new clinical standard of integrated quadruple stress echocardiography with ABCD protocol
title_full The new clinical standard of integrated quadruple stress echocardiography with ABCD protocol
title_fullStr The new clinical standard of integrated quadruple stress echocardiography with ABCD protocol
title_full_unstemmed The new clinical standard of integrated quadruple stress echocardiography with ABCD protocol
title_short The new clinical standard of integrated quadruple stress echocardiography with ABCD protocol
title_sort new clinical standard of integrated quadruple stress echocardiography with abcd protocol
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167852/
https://www.ncbi.nlm.nih.gov/pubmed/30285774
http://dx.doi.org/10.1186/s12947-018-0141-z
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