Clinical and Diagnostic Value of ABCDE Stress Echocardiography With Exercise in Patients With Myocardial Infarction.

Abstract

Aim: Evaluation of the clinical and diagnostic role of stepwise stress echocardiography (Stress Echo) with exercise using the ABCDE protocol in patients with myocardial infarction (MI).

Material and methods: This single-site study included 75 patients (mean age 61.6±9.8 years; 84% men) after MI. The median time since MI was 1231.0 [381.5; 2698.5] days. All patients underwent Stress Echo using a five-step protocol. Step A identified impaired local contractility, step B identified the sum of B lines, step C identified the left ventricular (LV) contractile reserve, step D identified the coronary reserve in the anterior interventricular branch, and step E identified the heart rate reserve. The Stress Echo result was assessed by scores from 0 (all steps negative) to 5 (all steps positive). The effects of positive steps and the sum of Stress Echo scores on the incidence of the need for repeat revascularization were assessed.

Results: The frequency of positive results was 36% for step A, 18.7% for step B, 80.0% for step C, 53.3% for step D, and 50.7% for step E. In 4 (5.3%) patients, all steps were negative (score 0); in 3 patients (4%), they were positive (score 5). Coronary angiography after Stress Echo during the follow-up period was performed in 26 (34.7%) patients; the need for repeat revascularization was determined in 17 (22.7%) patients. The predictors of the need for repeat revascularization according to a multivariate analysis were positive step A, chest pain pattern, and LV end-diastolic volume at peak exercise (p<0.001). A statistically significant effect of positive step A on survival without a need for repeat revascularization was observed in patients with a history of MI (p=0.020).

Conclusion: Among all the parameters of the integrated approach with Stress Echo, the emergence of new areas of impaired LV local contractility in patients after MI remains the main guideline for prescribing an angiographic study and a significant predictor of a need for repeated revascularization. However, the study results suggest that a further investigation of the effect of each positive step and the total ABCDE Stress Echo score on the prognosis for postinfarction cardiovascular complications is promising.