Exercise stress echocardiography with ABCDE protocol in unexplained dyspnoea.
- 作者列表："Zagatina A","Zhuravskaya N","Shmatov D","Ciampi Q","Carpeggiani C","Picano E","Stress Echo 2020 study group of the Italian Society of Echocardiography, Cardiovascular Imaging.
: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).
: 目前的指南建议在不明原因呼吸困难患者中使用运动负荷超声心动图 (ESE)。SE最近被ABCDE方案改造: A用于asynergy，B用于b线 (4位点简化扫描)，C用于基于力的收缩储备，D用于基于多普勒的冠状动脉左前降支血流储备 (CFVR); 和E用于基于EKG的心率储备 (HRR，定义为峰值/静息心率 <1.62)。本研究的目的是确定以呼吸困难为主要症状的患者的ESE反应。从2018年在单中心接受半卧位ESE的初始患者人群中，我们根据主要症状: 呼吸困难 (组1，n = 100，62名男性，63 ± 10年) 或胸痛(组2，n = 100，男性58，年龄61 ± 8岁)。所有患者均接受了接受ABCDE方案的ESE治疗。步骤A、B、C、E的成功率为100%，步骤D的成功率为88%。A标准的阳性发生在组1的56例患者和组2的24例患者中 (p <0.0001)。B-line阳性 (stress > rest rest for ≥≥ 2分) 发生在组1的40例患者和组2的28例患者中 (p = 0.07)。LVCR阳性 (<2.0) 发生于组1的60例患者和组2的42例患者 (p <0.05)。组1中56例发生CFVR降低，组2中22例发生CFVR降低 (p <0.0001)。组1的44例患者和组2的22例患者存在钝化HRR (p <0.001)。总之，在不明原因的呼吸困难患者中，使用ABCDE方案的SE可用于记录呼吸困难的心脏起源，全面评估不仅集中在缺血 (a)，而且还集中在肺充血 (B)，心肌瘢痕或坏死 (C)，冠状动脉微血管功能障碍 (D)。或变时性无能 (E)。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.