The ABCDE-SE multi-marker protocol integrates five steps during a single stress test to assess distinct pathophysiological mechanisms, significantly refining risk stratification in suspected cardiac disease.
Does multi-marker stress echocardiography (ABCDE-SE) improve risk stratification compared to traditional single-marker stress echocardiography in patients with suspected cardiac disease?
The ABCDE-SE multi-marker stress echocardiography protocol provides a comprehensive functional assessment of patient vulnerability, refining risk stratification beyond traditional regional wall motion abnormality assessment.
Stress echocardiography (SE) has evolved beyond its traditional role of detecting coronary artery disease (CAD) through a single marker-regional wall motion abnormality (RWMA). This conventional approach, while guideline-embedded, faces a declining positivity rate and reduced prognostic power in today's diverse patient population. In response, SE has undergone a conceptual transformation into a multi-marker, comprehensive functional assessment of patient vulnerability. The modern multi-marker protocol, known as the ABCDE-SE, integrates five steps during a single stress test: Step A assesses RWMA for ischemia; Step B quantifies pulmonary congestion via B-lines and E/e'; Step C evaluates left ventricular volume response; Step D measures coronary flow velocity reserve for microvascular function; and Step E determines heart rate reserve for autonomic function. Each step identifies distinct pathophysiological mechanisms and actionable therapeutic targets, significantly refining risk stratification.Developed and validated over the past decade with the SE 2030 study (2016-2030), the flagship project of SIECVI, Italian Society of Echocardiography and Cardiovascular Imaging, and adopted by 50 laboratories from 20 countries, the ABCDE protocol represents a universal and widely accessible platform, applicable to all patients with suspected cardiac disease. It paves the way for personalized medicine by enabling tailored therapies targeted to the specific vulnerabilities.
Picano et al. (Wed,) conducted a review in Suspected cardiac disease. ABCDE-SE multi-marker protocol vs. Traditional single-marker stress echocardiography was evaluated. The ABCDE-SE multi-marker protocol integrates five steps during a single stress test to assess distinct pathophysiological mechanisms, significantly refining risk stratification in suspected cardiac disease.