With stress echo (SE) 2020 study, a new standard of practice in stress imaging was developed and disseminated: the ABCDE protocol for functional testing within and beyond CAD. ABCDE protocol was the fruit of SE 2020, and is the seed of SE 2030, which is articulated in 12 projects: 1-SE in coronary artery disease (SECAD); 2-SE in diastolic heart failure (SEDIA); 3-SE in hypertrophic cardiomyopathy (SEHCA); 4-SE post-chest radiotherapy and chemotherapy (SERA); 5-Artificial intelligence SE evaluation (AI-SEE); 6-Environmental stress echocardiography and air pollution (ESTER); 7-SE in repaired Tetralogy of Fallot (SETOF) ; 8-SE in post-COVID-19 (SECOV); 9: Recovery by stress echo of conventionally unfit donor good hearts (RESURGE); 10-SE for mitral ischemic regurgitation (SEMIR); 11-SE in valvular heart disease (SEVA); 12-SE for coronary vasospasm (SESPASM). The study aims to recruit in the next 5 years (2021–2025) ≥10,000 patients followed for ≥5 years (up to 2030) from ≥20 quality-controlled laboratories from ≥10 countries. In this COVID-19 era of sustainable health care delivery, SE2030 will provide the evidence to finally recommend SE as the optimal and versatile imaging modality for functional testing anywhere, any time, and in any patient.

Background Significant tricuspid regurgitation (TR) can be found in patients with atrial fibrillation (AF). The results of previous studies are controversial about whether significant functional TR (FTR) in patients with AF leads to worse clinical outcomes. The aims of the study were to investigate the prevalence, predictors and prognosis of significant FTR in patients with AF with preserved left ventricular ejection fraction (LVEF). Methods The present study was a retrospective cohort study in patients with AF and preserved LVEF from May 2013 through January 2018. Significant FTR was defined as moderate to severe TR without structural abnormality of the tricuspid valve. Pulmonary hypertension (PH) was defined as pulmonary artery systolic pressure ≥ 50 mmHg or mean pulmonary artery pressure ≥ 25 mmHg determined by echocardiography. The adverse outcomes were defined as heart failure and death from any cause within 2 years of follow up. Results A total of 300 patients with AF (mean age 68.8 ± 10.8 years, 50% male) were included in the study. Paroxysmal and non-paroxysmal AF were reported in 34.7 and 65.3% of patients, respectively. Mean LVEF was 65.3 ± 6.3%. PH and significant FTR were observed in 31.3 and 21.7% of patients, respectively. Patients with significant FTR were significantly older, more female gender and non-paroxysmal AF, and had higher left atrial volume index and pulmonary artery pressure than those without. A total of 26 (8.7%) patients died and heart failure occurred in 39 (13.0%) patients. There was a statistically significant difference in the adverse outcomes between patients with significant and insignificant FTR (44.6% vs. 11.9%, p <  0.010). Multivariable analysis showed that factors associated with significant FTR were female gender, presence of PH and left atrial volume index (OR = 2.61, 1.87, and 1.04, respectively). The predictors of the adverse outcomes in patients with AF were significant FTR, presence of PH and high CHA2DS2-VASc score (OR = 5.23, 2.23 and 1.60, respectively). Conclusions Significant FTR was common in patients with AF, and independently associated with adverse outcomes. Thus, comprehensive echocardiographic assessment of FTR in patients with AF and preserved LVEF is fundamental in determining the optimal management.

BackgroundThe common pathophysiological consequences of chronic mitral regurgitation (MR) are left atrial (LA) remodeling/dilatation and pulmonary hypertension (PH). We aimed to study the association between LA volume (LAV) and PH in patients with chronic organic MR.MethodsWe prospectively studied 154 patients (age 55.0 ± 16.4 years, 39.6 % female) with isolated moderate to severe chronic organic MR. Severity of MR was assessed using proximal isovelocity surface area method. LAV was assessed using the area-length biplane method. PH was defined as pulmonary artery systolic pressure > 50 mmHg.ResultsRuptured chordae and flail leaflets were the most common etiology of MR (53.2 %). Severe MR (effective regurgitant orifice area (EROA) > 40 mm2) was described in 123 (79.9 %) patients. Dyspnea, history of heart failure and atrial fibrillation was reported in 37.7 %, 20.1 % and 29.4 % of patients, respectively. Left ventricular (LV) ejection fraction was 68.1 ± 5.9 %. LAV index and EROA were 67.1 (24.7–391.3) ml/m2and 60.3 (10.5–250.9) mm2, respectively. Age, presence of atrial fibrillation, EROA, LV end-systolic and end-diastolic volume, LV mass index, LAV index and tricuspid annular plane systolic excursion were all factors univariately associated with PH. In multiple logistic regression analysis, age (OR = 1.03, 95 % CI: 1.001-1.06, p = 0.04), EROA (OR = 1.02, 95 % CI: 1.003-1.03, p = 0.017) and LAV index (OR = 1.01, 95 % CI: 1.002-1.02, p = 0.021) were independently associated with PH.ConclusionsIn patients with chronic organic MR, a significant association exists between LAV index and PH. Age, the severity of MR as assessed by EROA, and LAV index are the independent determinants of PH.