title: Stress echo 2020: the international stress echo study in ischemic and non-ischemic heart disease.
abstract: BACKGROUND
  Stress echocardiography (SE) has an established role in evidence-based guidelines, but recently its breadth and variety of applications have extended well beyond coronary artery disease (CAD). We lack a prospective research study of SE applications, in and beyond CAD, also considering a variety of signs in addition to regional wall motion abnormalities.
  
  
  METHODS
  In a prospective, multicenter, international, observational study design, > 100 certified high-volume SE labs (initially from Italy, Brazil, Hungary, and Serbia) will be networked with an organized system of clinical, laboratory and imaging data collection at the time of physical or pharmacological SE, with structured follow-up information. The study is endorsed by the Italian Society of Cardiovascular Echography and organized in 10 subprojects focusing on: contractile reserve for prediction of cardiac resynchronization or medical therapy response; stress B-lines in heart failure; hypertrophic cardiomyopathy; heart failure with preserved ejection fraction; mitral regurgitation after either transcatheter or surgical aortic valve replacement; outdoor SE in extreme physiology; right ventricular contractile reserve in repaired Tetralogy of Fallot; suspected or initial pulmonary arterial hypertension; coronary flow velocity, left ventricular elastance reserve and B-lines in known or suspected CAD; identification of subclinical familial disease in genotype-positive, phenotype- negative healthy relatives of inherited disease (such as hypertrophic cardiomyopathy).
  
  
  RESULTS
  We expect to recruit about 10,000 patients over a 5-year period (2016-2020), with sample sizes ranging from 5,000 for coronary flow velocity/ left ventricular elastance/ B-lines in CAD to around 250 for hypertrophic cardiomyopathy or repaired Tetralogy of Fallot. This data-base will allow to investigate technical questions such as feasibility and reproducibility of various SE parameters and to assess their prognostic value in different clinical scenarios.
  
  
  CONCLUSIONS
  The study will create the cultural, informatic and scientific infrastructure connecting high-volume, accredited SE labs, sharing common criteria of indication, execution, reporting and image storage of SE to obtain original safety, feasibility, and outcome data in evidence-poor diagnostic fields, also outside the established core application of SE in CAD based on regional wall motion abnormalities. The study will standardize procedures, validate emerging signs, and integrate the new information with established knowledge, helping to build a next-generation SE lab without inner walls.
authors.affiliation: Institute of Clinical Physiology, National Research Council, Pisa, Italy. picano@ifc.cnr.it.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
authors.affiliation: Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy.
authors.forename: Quirino
authors.initials: Q
authors.lastname: Ciampi
authors.affiliation: Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Citro
authors.affiliation: Division of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: D'Andrea
authors.affiliation: Cardiology Department, Pisa University and Nottola (Siena) Hospital, Pisa, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Scali
authors.affiliation: Cardiology Department, San Luca Hospital, Lucca, Italy.
authors.forename: Lauro
authors.initials: L
authors.lastname: Cortigiani
authors.affiliation: Cardiology Department, Careggi Hospital, Florence, Italy.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Olivotto
authors.affiliation: Cardiology Department, Careggi Hospital, Florence, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Mori
authors.affiliation: Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Galderisi
authors.affiliation: Cardiology Department, San Carlo Hospital, Potenza, Italy.
authors.forename: Marco Fabio
authors.initials: MF
authors.lastname: Costantino
authors.affiliation: Institute of Clinical Physiology, National Research Council, Pisa, Italy.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Pratali
authors.affiliation: Pediatric Cardiology Department, Brompton Hospital, London, UK.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Salvo
authors.affiliation: Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.affiliation: Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ferrara
authors.affiliation: Institute of Clinical Physiology, National Research Council, Pisa, Italy.
authors.forename: Luna
authors.initials: L
authors.lastname: Gargani
authors.affiliation: Division of Cardiology, Ospedale dell'Angelo Mestre-Venice, Mestre, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Rigo
authors.affiliation: Cardiology Department, Parma University Hospital, Parma, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Gaibazzi
authors.affiliation: Pediatric Cardiology Department, Monaldi Hospital Clinics, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Limongelli
authors.affiliation: Division of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pacileo
authors.affiliation: Institute of Clinical Physiology, National Research Council, Pisa, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Andreassi
authors.affiliation: Cardiology Department, University Hospital "Ospedale Riuniti", Trieste, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pinamonti
authors.affiliation: Cardiology Department, University Hospital "Ospedale Riuniti", Trieste, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Massa
authors.affiliation: Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Marco A R
authors.initials: MA
authors.lastname: Torres
authors.affiliation: Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Marcelo H
authors.initials: MH
authors.lastname: Miglioranza
authors.affiliation: Cardiology Division, Hospital San José, Criciuma, Brazil.
authors.forename: Clarissa Borguezan
authors.initials: CB
authors.lastname: Daros
authors.affiliation: Hospital Sao Vicente de Paulo, Hospital de Cidade, Passo Fundo, Brazil.
authors.forename: José Luis
authors.initials: JL
authors.lastname: de Castro E Silva Pretto
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia.
authors.forename: Branko
authors.initials: B
authors.lastname: Beleslin
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia.
authors.forename: Ana
authors.initials: A
authors.lastname: Djordjevic-Dikic
authors.affiliation: Institute of Family Medicine, University of Szeged, Szeged, Hungary.
authors.forename: Albert
authors.initials: A
authors.lastname: Varga
authors.affiliation: Department of Internal Medicine, Elisabeth Hospital, Hodmezovasarhely, Hungary.
authors.forename: Attila
authors.initials: A
authors.lastname: Palinkas
authors.affiliation: Institute of Family Medicine, University of Szeged, Szeged, Hungary.
authors.forename: Gergely
authors.initials: G
authors.lastname: Agoston
authors.affiliation: Department of Biostatistics, University of Padua, Padua, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Gregori
authors.affiliation: Department of Cardiology, Sandro Pertini Hospital, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Trambaiolo
authors.affiliation: Cardiology Department, Monaldi Hospital, Naples, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Severino
authors.affiliation: RSE, Medical Centre Hospital of the President's Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan.
authors.forename: Ayana
authors.initials: A
authors.lastname: Arystan
authors.affiliation: Institute of Clinical Physiology, National Research Council, Pisa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Paterni
authors.affiliation: Institute of Clinical Physiology, National Research Council, Pisa, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Carpeggiani
authors.affiliation: Cardiology Hospital, Policlinico of Bari, Bari, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Colonna
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000503:physiopathology; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D015203:Reproducibility of Results
keywords: Effectiveness; Imaging; Prognosis; Stress echocardiography