Multiple Phenotypes of Chronic Coronary Syndromes Identified by ABCDE Stress Echocardiography.
BACKGROUND Regional wall motion abnormality (RWMA) is considered a sensitive and specific marker of ischemia during stress echocardiography (SE). However, ischemia is a multifaceted entity associated with either coronary artery disease (CAD) or angina with normal coronary arteries (ANOCA), a distinction difficult to make using a single sign. We aimed to evaluate the diagnostic potential of the ABCDE-SE protocol for CAD detection. METHODS From the 2016-2022 SE-2030 study data bank, we selected 3229 patients (age= 66±12 years, 2089, 65% males), with known CAD (n=1792) or ANOCA (n= 1437). All patients were studied with both ABCDE-SE protocol and with coronary angiography, within 3 months. Step A assesses RWMA; step B, B-lines/diastolic function; step C, left ventricular contractile reserve; step D, coronary flow velocity reserve (CFVR) in the left anterior descending artery; step E, heart rate reserve. RESULTS SE response ranged from score 0 (all steps normal) to score 5 (all steps abnormal) . In CAD, the rate of abnormal results was 347 for A (19.4%), 547 (30.5%) for B, 720 (40.2%) for C, 615 (34.3%) for D, and 633 (35.3%) for E step. In ANOCA, the rate of abnormal results was 81 (5.6%) for A, 429 (29.9%) for B, 432 (30.1%) for C, 354 (24.6%) for D, and 445 (31.0%) for E step. The dominant "solitary phenotype" was step B in 109 (9.1%) patients. CONCLUSION Stress-induced ischemia presents with a wide range of diagnostic phenotypes, highlighting its complex nature. Utilizing a comprehensive approach such as the advanced ABCDE score, which combines multiple markers, proves to be more valuable than relying on a single marker in isolation.