Prognostic value of multi-marker stress echocardiography

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.

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Publication Details

Journal
Future Cardiology
Published
2026-04-22
DOI
https://doi.org/10.1080/14796678.2026.2659089
Primary Topic
Cardiac Imaging and Diagnostics
Type
article
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article

Prognostic value of multi-marker stress echocardiography

T. N. Timofeeva, Hector R. Villarraga, Luigi Gerra, Jorge Alfredo Lowenstein et al.
Future Cardiology
Cardiac Imaging and Diagnostics
article

Prognostic value of multi-marker stress echocardiography

T. N. Timofeeva, Hector R. Villarraga, Luigi Gerra, Jorge Alfredo Lowenstein, Patricia A. Pellikka, Scipione Carerj, Karina Wierzbowska‐Drabik, Ratnasari Padang, Jelena Čelutkienė, Laura Balkevičienė, Dimitrios Soulis, О. А. Журавлева, Adelaide M. Arruda‐Olson, Lauro Cortigiani, Nicola Gaibazzi, Elisa Merli, Francesca Bursi, F Manganelli, Q C Quirino Ciampi, S K Sergio Kobal, R O S I N A Arbucci, Ariel Saad, Hugo Rodriguez-Zanella, Ana Djordjevic-Dikic, Angela Zagatina, Alla Boshchenko, Yì Xiáng J. Wáng, Eugenio Picano, Ayten Safarova, Lixue Yin, Miodrag Ostojic, Tamara Kovacevic-Preradovic, Garvan C. Kane, Jaroslaw D. Kasprzak, Jesus Peteiro Vazquez, Clarissa Borguesan-Daros, Aleksandra Nikolic
article en

Abstract

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.

Future Cardiology
University of Parma (IT), AOL (United States) (US), Russian Academy of Sciences (RU), St Petersburg University (RU), Vilnius University (LT), University of Banja Luka (BA), Soroka Medical Center (IL), WinnMed (US), University Medical Center (US), University of Belgrade (RS), Ospedale "Santa Maria delle Croci" di Ravenna (IT), Hospital de São José (PT), Chikamori Hospital (JP), Cytodiagnostics (Canada) (CA), Center for Health, Exercise and Sport Sciences (RS), Instituto Nacional de Cardiologia (BR), Fatebenefratelli Hospital (IT), University Hospital and Clinics (US), Azienda Ospedaliera S.Giuseppe Moscati (IT), Centar za Promociju Nauke (RS), Ospedale Santa Maria (IT), Tomsk National Research Medical Center (RU), Hospital de Clínicas "José de San Martín" (AR), Ospedale per gli Infermi (IT), University Clinical Centre (PL), Ospedaliera di Piacenza (IT), Azienda Ospedaliera Universitaria Policlinico "G. Martino" (IT), Complexo Hospitalario Universitario A Coruña (ES), Ospedale degli Infermi (IT), University clinical center of Republika Srpska (BA), Indiana University School of Medicine
Partnerships for the goals
Openalex Percentile: Top 13%
Cardiac Imaging and Diagnostics
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