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• W3021773485 abstract "Stress echocardiography (SE) is an excellent noninvasive means of identifying flow-limiting coronary stenosis. 1 Pellikka P.A. Arruda-Olson A. Chaudhry F.A. Chen M.H. Marshall J.E. Porter T.R. et al. Guidelines for performance, interpretation, and application of stress echocardiography in ischemic heart disease: from the American Society of Echocardiography. J Am Soc Echocardiogr. 2020; 33 (1-41.e8) Abstract Full Text Full Text PDF Scopus (141) Google Scholar ,2 Heijenbrok-Kal M.H. Fleischmann K.E. Hunink M.G. Stress echocardiography, stress single-photon-emission computed tomography and electron beam computed tomography for the assessment of coronary artery disease: a meta-analysis of diagnostic performance. Am Heart J. 2007; 154: 415-423 Crossref PubMed Scopus (144) Google Scholar However, while desirable, a normal stress echocardiogram does not translate into a zero cardiovascular event rate. A normal exercise echocardiogram is associated with a 1% annual event rate of cardiac death or nonfatal myocardial infarction (MI). 3 Sawada S.G. Ryan T. Conley M.J. Corya B.C. Feigenbaum H. Armstrong W.F. Prognostic value of a normal exercise echocardiogram. Am Heart J. 1990; 120: 49-55 Crossref PubMed Scopus (133) Google Scholar ,4 McCully R.B. Roger V.L. Mahoney D.W. Karon B.L. Oh J.K. Miller Jr., F.A. et al. Outcome after normal exercise echocardiography and predictors of subsequent cardiac events: follow-up of 1,325 patients. J Am Coll Cardiol. 1998; 31: 144-149 Crossref PubMed Scopus (183) Google Scholar This is not surprising given that the majority of myocardial events occur secondary to the rupture of mildly stenotic atherosclerotic plaque (i.e., <50% stenosis), 5 Ambrose J.A. Tannenbaum M.A. Alexopoulos D. Hjemdahl-Monsen C.E. Leavy J. Weiss M. et al. Angiographic progression of coronary artery disease and the development of myocardial infarction. J Am Coll Cardiol. 1988; 12: 56-62 Crossref PubMed Scopus (1213) Google Scholar ,6 Hackett D. Verwilghen J. Davies G. Maseri A. Coronary stenoses before and after acute myocardial infarction. Am J Cardiol. 1989; 63: 1517-1518 Abstract Full Text PDF PubMed Scopus (61) Google Scholar which would not have been identified on a stress echocardiogram. Hence early recognition and identification of atherosclerotic plaque is key in the prevention of atherosclerotic cardiovascular events. Accordingly, there has been a decisive shift in the prevention of cardiovascular disease (CVD) from being reactive to being proactive. Therefore, there is now a move away from focusing only on detecting flow-limiting coronary stenosis to identifying individuals with subclinical atherosclerosis. 7 Naghavi M. Falk E. Hecht H.S. Jamieson M.J. Kaul S. Berman D. et al. From vulnerable plaque to vulnerable patient—Part III: executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) task force report. Am J Cardiol. 2006; 98: 2-15 Abstract Full Text Full Text PDF PubMed Scopus (526) Google Scholar A stress test that is typically done for evaluating symptoms and that most often tends to be normal 8 Arbab-Zadeh A. Stress testing and non-invasive coronary angiography in patients with suspected coronary artery disease: time for a new paradigm. Heart Int. 2012; 7: e2 Crossref PubMed Scopus (43) Google Scholar can provide an excellent opportunity to be proactive in terms of CVD prevention if subclinical atherosclerosis can be identified. In this issue of the Journal of American Society of Echocardiography, Ahmadvazir et al.9 Ahmadvazir S. Pradhan J. Kattar R.S. Senior R. Long-term prognostic value of simultaneous assessment of atherosclerosis and ischemia in patients with suspected angina: implications for routine use of carotid ultrasound during stress echocardiography. J Am Soc Echocardiogr. 2020; 33: 559-569 Abstract Full Text Full Text PDF Scopus (5) Google Scholar extend their previous data in combining a carotid ultrasound (US) with an echocardiographic stress test to demonstrate the potential for enhanced risk stratification and improved prevention. Long-Term Prognostic Value of Simultaneous Assessment of Atherosclerosis and Ischemia in Patients with Suspected Angina: Implications for Routine Use of Carotid Ultrasound during Stress EchocardiographyJournal of the American Society of EchocardiographyVol. 33Issue 5PreviewWhile the impact of carotid plaque on cardiovascular events is well investigated in asymptomatic epidemiologic studies, the long-term clinical impact of carotid plaque and its burden (CPB) in patients with new-onset suspected stable angina with no history of coronary artery disease beyond stress echocardiography (SE) is not known. We sought to investigate this with a prospective study, where patients were followed up for adverse events. Full-Text PDF" @default.
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• W3021773485 title "“Sound” Advice—Let's “Stress” the Importance of Prevention: Combining Carotid Ultrasound and Stress Echocardiography for Cardiovascular Risk Assessment" @default.
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