Highlights 2024

Highlights

The renaissance of stress

The renaissance of stress echo at the age of sustainability: from the diagnostic focus on coronary artery stenosis to the panoramic view on patient vulnerability with ABCDE protocol: step A for wall motion; step B for B-lines, step C for contractile reserve, step D for doppler based coronary flow velocity reserve; step E for ECG-based heart rate reserve. The good cardiologist treats coronary artery stenosis, but the best cardiologist treats the patient vulnerability, and every letter is a risk stratifier and an actionable therapeutic target

Highlights

CARDIAC TESTING WITH IONIZING RADIATION MAY INCREASE THE SUBSEQUENT RISK OF CANCER

We know since decades that cancer radiotherapy may cause cardiovascular disease years down the line, but there is also biological clinical and epidemiological evidence that cardiac diagnostic and therapeutic interventions may cause an increased risk of cancer already detectable after a few years.

Highlights

Choose your test but choose wisely

Choose your test but choose wisely, knowing that every test is a cost, a risk, and an environmental impact. The choice of a medical test is a social not only a medical act. Avoid to your patient the Ulysses’ syndrome. The journey of Ulysses serves as a metaphor for the diagnostic process in patients with suspected coronary artery disease. With conservative estimates, the cumulative cost of serial imaging testing exceeds that of a simple exercise electrocardiogram by >100-fold. The total radiation exposure is equivalent to >2000 chest X-rays. The environmental impact surpasses 250 kg of carbon dioxide emissions. The overall cumulative complication rate exceeds 1%. Bring the patient back to Ithaca of wise and targeted clinically-driven testing.

As the great Greek poet Konstantinos Kafavis wrote in Ithaca (1911): ‘Ithaka gave you the marvelous journey. Without her, you would not have set out. She has nothing left to give you now. And if you find her poor, Ithaka won’t have fooled you. Wise as you will have become, so full of experience, you will have understood by then what these Ithakas mean.’

Highlights

Stress echo 2030 study

The ABCDE stress echocardiography protocol represents a novel, inclusive, and versatile standard for cardiac functional stress testing. It marks a departure from the traditional, narrowly focused anatomical approach centered on the “oculo-stenotic reflex,” which emphasized the diagnosis of epicardial coronary artery stenosis. Instead, the ABCDE protocol embraces a more pathophysiologically comprehensive perspective, addressing multiple dimensions of patient vulnerability:

A: Detection of regional wall motion abnormalities for assessing coronary stenosis.

B: Evaluation of pulmonary congestion through B-lines, reflecting alveolar-capillary barrier integrity.

C: Assessment of myocardial function via cardiac reserve.

D: Examination of coronary microvascular disease using Doppler-based coronary flow velocity reserve.

E: Measurement of cardiac autonomic function through heart rate reserve derived from ECG.
These five parameters are seamlessly integrated within the ABCDE framework, offering conceptual, logistical, and methodological coherence. The protocol is adaptable to various physical and pharmacological stress tests and is applicable to patients with coronary artery disease and beyond.
Furthermore, the ABCDE protocol aligns with the demands of the COVID-19 era, prioritizing economic, radiological, environmental, and societal sustainability in the context of the “Green Imaging New Deal.”
This comprehensive and future-ready approach ensures a holistic evaluation of cardiac health while addressing contemporary healthcare challenges