From the Guidelines
Atherosclerotic cardiovascular disease (ASCVD) does not necessarily require 2D echocardiography (2Decho) for diagnosis, as the 2019 ESC Guidelines on the management of chronic coronary syndromes recommend a more comprehensive approach including resting echocardiography and CMR in initial diagnostic management, with a Class I, Level B recommendation 1.
Diagnostic Approach
The diagnosis of ASCVD involves a combination of clinical history, physical examination, laboratory tests, and various imaging modalities. According to the 2019 ESC Guidelines, resting echocardiography and CMR are recommended for the initial diagnostic management of patients with suspected CAD, with the aim of excluding alternative causes of angina, identifying regional wall motion abnormalities suggestive of CAD, measuring LVEF for risk-stratification purposes, and evaluating diastolic function 1.
Imaging Modalities
While 2Decho can be useful for assessing cardiac structure and function, other tests are often more appropriate for diagnosing ASCVD specifically. These include:
- Coronary angiography, considered the gold standard for coronary artery disease
- Coronary CT angiography, which provides detailed images of coronary arteries
- Stress tests to evaluate cardiac function during exertion
- Carotid ultrasound to assess plaque buildup in neck arteries, which is recommended to be performed by adequately trained clinicians to detect plaque in patients with suspected CCS without known atherosclerotic disease, with a Class IIa, Level C recommendation 1
Blood Tests and Risk Stratification
Blood tests measuring lipid profiles, inflammatory markers, and cardiac enzymes also play important roles in diagnosis. The 2019 ESC Guidelines recommend risk stratification based on clinical assessment and the result of the diagnostic test initially employed for making a diagnosis of CAD, with a Class I, Level B recommendation 1. Resting echocardiography is recommended to quantify LV function in all patients with suspected CAD, with a Class I, Level C recommendation 1.
Conclusion is not allowed, so the answer just ends here.
From the Research
Diagnosis of Atherosclerotic Cardiovascular Disease (ASCVD)
- ASCVD diagnosis is not limited to a single method, and various techniques can be employed to assess the risk and presence of the disease 2, 3.
- The use of coronary artery calcium scoring (CAC) and CT coronary angiography (CCTA) can provide complementary tools to directly visualize coronary plaque and other risk-modifying imaging components 2.
- Risk calculators based on clinical and laboratory traditional risk factors plus risk enhancers are commonly used to identify individuals at risk, but they may misclassify a significant proportion of individuals 2, 3.
- Screening for subclinical atherosclerosis, especially with the use of coronary calcium screening, can further inform the treatment decision if uncertain based on the above strategies 3.
Role of 2D Echo in ASCVD Diagnosis
- There is no direct evidence to suggest that 2D echo must be used for the diagnosis of ASCVD 2, 3, 4, 5, 6.
- While 2D echo can be used to assess cardiac function and structure, other imaging modalities such as CAC and CCTA are more specific for the detection of coronary atherosclerosis 2.
- The diagnosis and management of ASCVD involve a comprehensive approach, including risk assessment, lifestyle modification, and pharmacologic therapy, rather than relying on a single diagnostic test 3, 5, 6.