Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation.
Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy.
Int J Cardiovasc Imaging. 2020 May;36(5):823-831. doi: 10.1007/s10554-020-01789-6. Epub 2020 Feb 8.
Current guidelines recommend the use of exercise stress echocardiography (ESE) in patients with unexplained dyspnoea. SE was recently reshaped with the ABCDE protocol: A for asynergy, B for B-lines (4-site simplified scan), C for contractile reserve based on force, D for Doppler-based coronary flow velocity reserve (CFVR) in left anterior descending coronary artery; and E for EKG-based heart rate reserve (HRR, defined as peak/rest HR < 1.62). Aim of the study was to define the ESE response in patients with dyspnoea as the main symptom. From the initial population of patients referred in 2018 in a single center for semi-supine ESE, we selected two groups (without history of previous myocardial infarction or coronary revascularization) on the basis of the main presenting symptom: dyspnoea (Group 1, n = 100, 62 men, 63 ± 10 years) or chest pain (Group 2, n = 100, 58 men, age 61 ± 8 years). All underwent ESE with ABCDE protocol. Success rate was 100% for steps A, B, C, E, and 88% for step D. Positivity for A criterion occurred in 56 patients of Group 1 and 24 of Group 2 (p < 0.0001). B-lines positivity (stress > rest for ≥ 2 points) occurred in 40 patients of Group 1 and 28 of Group 2 (p = 0.07). LVCR positivity (< 2.0) occurred in 60 patients of Group 1 and 42 of Group 2 (p < 0.05). A reduced CFVR occurred in 56 of Group 1 and 22 of Group 2 (p < 0.0001). A blunted HRR was present in 44 patients of Group 1 and 22 of Group 2 (p < 0.001). In conclusion, in patients with unexplained dyspnoea, SE with ABCDE protocol is useful to document the cardiac origin of dyspnoea with a comprehensive assessment focused not only on ischemia (A) but also pulmonary congestion (B), myocardial scar or necrosis (C), coronary microvascular dysfunction (D) or chronotropic incompetence (E).
目前的指南建议将运动超声心动图（ESE）用于不明原因呼吸困难的患者。SE 最近采用 ABCDE 方案进行了重塑：A 代表失协同，B 代表 B 线（4 点简化扫描），C 代表基于力的收缩储备，D 代表左前降支冠状动脉的基于多普勒的冠状动脉血流储备（CFVR），E 代表基于心电图的心率储备（HRR，定义为峰值/休息时 HR<1.62）。本研究的目的是定义以呼吸困难为主要症状的 ESE 反应。从 2018 年在一个中心进行半卧位 ESE 的初始患者人群中，我们根据主要的首发症状选择了两组（无先前心肌梗死或冠状动脉血运重建史）：呼吸困难（第 1 组，n=100，62 名男性，63±10 岁）或胸痛（第 2 组，n=100，58 名男性，年龄 61±8 岁）。所有患者均采用 ABCDE 方案进行 ESE。A、B、C、E 步骤的成功率为 100%，D 步骤的成功率为 88%。第 1 组 56 例和第 2 组 24 例患者 A 标准阳性（<0.0001）。第 1 组 40 例和第 2 组 28 例患者 B 线阳性（应激>休息≥2 分）（p=0.07）。第 1 组 60 例和第 2 组 42 例患者左心室收缩储备阳性（<2.0）（p<0.05）。第 1 组 56 例和第 2 组 22 例患者冠状动脉血流储备减少（<0.0001）。第 1 组 44 例和第 2 组 22 例患者 HRR 降低（<0.001）。总之，对于不明原因呼吸困难的患者，采用 ABCDE 方案的 ESE 有助于通过综合评估来确定呼吸困难的心脏起源，不仅关注缺血（A），还关注肺充血（B）、心肌瘢痕或坏死（C）、冠状动脉微血管功能障碍（D）或变时功能不全（E）。
