The prognostic value of positive stress echocardiography and its relationship with invasive coronary angiography: Rationale and design of the multicenter stress echo trial – AMPHIPOLIS

Introduction/aim: Stress echocardiography (SE) is a first-line, non-invasive and well-validated technique for the diagnosis and decision making of coronary artery disease (CAD). The introduction of echocardiographic contrast agents, the growing usage of exercise on supine bike as a stressor and the recent technological advances have considerably improved the sensitivity of SE. Despite those advantages, SE remains an operator-dependent technique, and its association with CAD prognosis is based on limited evidence from old studies. Our aim is a) to assess the positive prognostic value of SE in patients with established or suspected CAD and b) to evaluate the relationship between SE findings and invasive coronary angiography (ICA) findings.

Methods: We describe the rationale and design of Amphipolis trial, a prospective, multicentre, self-controlled, open-label trial from 22 labs in Greece and Cyprus. We plan to enrol 390 consecutive adults with a positive SE based on echocardiographic findings, fulfilling specific selection criteria. All participants will undergo ICA within 6 weeks from positive SE. Then, we will be followed up them for at least 12 months for major adverse cardiovascular events (MACE) such as cardiovascular death, acute coronary syndrome (ACS), revascularization interventions (re-stenosis or new cases of myocardial ischemia), or the development of symptoms (angina relapse or new onset).

Conclusions: Amphipolis trial will test the prognostic role of SE, and its implementation in clinical practice along with anatomical findings from ICA.