Stress Echo 2030: The Novel ABCDE-(FGLPR) Protocol to Define the Future of Imaging

Abstract

With stress echo (SE) 2020 study, a new standard of practice in stress imaging was developed and disseminated: the ABCDE protocol for functional testing within and beyond CAD. ABCDE protocol was the fruit of SE 2020, and is the seed of SE 2030, which is articulated in 12 projects: 1-SE in coronary artery disease (SECAD); 2-SE in diastolic heart failure (SEDIA); 3-SE in hypertrophic cardiomyopathy (SEHCA); 4-SE post-chest radiotherapy and chemotherapy (SERA); 5-Artificial intelligence SE evaluation (AI-SEE); 6-Environmental stress echocardiography and air pollution (ESTER); 7-SE in repaired Tetralogy of Fallot (SETOF) ; 8-SE in post-COVID-19 (SECOV); 9: Recovery by stress echo of conventionally unfit donor good hearts (RESURGE); 10-SE for mitral ischemic regurgitation (SEMIR); 11-SE in valvular heart disease (SEVA); 12-SE for coronary vasospasm (SESPASM). The study aims to recruit in the next 5 years (2021–2025) ≥10,000 patients followed for ≥5 years (up to 2030) from ≥20 quality-controlled laboratories from ≥10 countries. In this COVID-19 era of sustainable health care delivery, SE2030 will provide the evidence to finally recommend SE as the optimal and versatile imaging modality for functional testing anywhere, any time, and in any patient.

Exercise stress echocardiography: Where are we now?

“…This protocol has been used in the last 5 years in the SE2020 study[ 94 - 96 ], demonstrating utility in defining diagnosis and prognosis criteria with the new data acquired and evaluated with this methodology. This protocol will be now expanded in the new SE2030 study[ 97 ], with selected patients by further evaluating flows (mitral regurgitation flow) gradients (intraventricular or valvular gradient), left atrium volume , pulmonary circulation , and right ventricular function . These new steps should be viewed as diagnostic tools that can be used for each patient, according to the clinical condition and question to be answered, to obtain essential information for helping cardiologists design the most appropriate tests for each patient.…”

Exercise Stress Echocardiography for Stable Coronary Artery Disease: Succumbed to the Modern Conceptual Revolution or Still Alive and Kicking?

“…The combination of anatomical and functional "hybrid" imaging is appealing and provides a new frontier in ESE. Recent developments in the integration of different ESE parameters into a "quadruple protocol" (coronary velo city flow reserve, regional wall motion abnormalities, left ventricular contractile reserve, and stress-induced B-lines) [ [112][113][114][115] allow for potential incremental prognostication, identifies patients who may benefit from secondary prevention, and improves diagnostic accuracy and risk stratification [116]. However, although coronary flow velocity reserve in the left anterior descending coronary can be obtained during all forms of stress echocardiography with overall feasibility of 80% for ESE in the largescale, international, observational Stress Echo 2020 [117], the experience is limited mainly to vasodilator stress echocardiography.…”

The venous contribution to cardiovascular performance: From systemic veins to left ventricular function: A review

“…[8][9][10][11][12][13] Thus, the gradient for venous return (VR) is somewhere between 5 and 10 mmHg and therefore the change in CVP of just by a few mmHg can have a considerable effect on venous return. 11 Table 1: Distribution of blood and pressures ranges for indicative aggregate data in the various components of the circulatory system at rest and during exercise or heart failure 2,42,46,47,49 an augmentation of both stroke volume and heart rate, 16 whereas the further increases in output during strenuous exercise result primarily from an increase in heart rate. 17 In healthy individuals, during peak aerobic exercise there is very little change in right atrial pressure with the very large increases in CO 7 and more venous return.…”

“…Mean systemic venous pressure can be estimated with a method based on the haemodynamic effects of mechanical ventilation: mechanical ventilation with positive airway pressures increases intrathoracic pressures, causing an increase in CVP and a decrease in venous return and CO. With the use of inspiratory holds (inspirato- 2,24,47,49 Table 3: Invasive vs noninvasive measurement of pressure ranges 24,19,41,46,47 ry hold = a ventilating manoeuvre in which the delivered volume of gas is held in the lung for a while before expiration) haemodynamic steadystate conditions were met to assure that venous return and CO were equal. CVP and pulmonary artery flow were measured at the end of each inspiratory hold.…”

“…As always, also the parameters of venous interest are more informative when tested both at baseline and during stress, since alterations occur in resting conditions can show-up under dynamic real life loading conditions. [46][47][48] At an early stage of disease, the function is not altered at rest but the possibility to increase function during stress can be already impaired. This is true for instance for left ventricular contractile reserve testing the myocardium, on the basis of its contraction capability, or coronary flow reserve testing the coronary microcirculation on the basis of vasodilatory capacity.…”