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Donal E, Galli E, Paven E, Sade LE. Haemodynamic evaluation: a key tool for heart failure management. Ultrasounds forever! Eur J Heart Fail 2020; 23:713-715. [PMID: 33215841 DOI: 10.1002/ejhf.2055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Erwan Donal
- CHU Rennes, Inserm, LTSI - UMR 1099, University of Rennes, Rennes, France
| | - Elena Galli
- CHU Rennes, Inserm, LTSI - UMR 1099, University of Rennes, Rennes, France
| | - Elise Paven
- CHU Rennes, Inserm, LTSI - UMR 1099, University of Rennes, Rennes, France
| | - Leyla Elif Sade
- Department of Cardiology, University of Baskent, Ankara, Turkey
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Popescu (Chair) BA, Stefanidis A, Fox KF, Cosyns B, Delgado V, Di Salvo GD, Donal E, Flachskampf FA, Galderisi M, Lancellotti P, Muraru D, Sade LE, Edvardsen T. Training, competence, and quality improvement in echocardiography: the European Association of Cardiovascular Imaging Recommendations: update 2020. Eur Heart J Cardiovasc Imaging 2020; 21:1305-1319. [DOI: 10.1093/ehjci/jeaa266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022] Open
Abstract
Abstract
The primary mission of the European Association of Cardiovascular Imaging (EACVI) is ‘to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging’. Echocardiography is a key component in the evaluation of patients with known or suspected cardiovascular disease and is essential for the high quality and effective practice of clinical cardiology. The EACVI aims to update the previously published recommendations for training, competence, and quality improvement in echocardiography since these activities are increasingly recognized by patients, physicians, and payers. The purpose of this document is to provide the general requirements for training and competence in echocardiography, to outline the principles of quality evaluation, and to recommend a set of measures for improvement, with the ultimate goal of raising the standards of echocardiographic practice. Moreover, the document aims to provide specific guidance for advanced echo techniques, which have dramatically evolved since the previous publication in 2009.
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Affiliation(s)
- Bogdan A Popescu (Chair)
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila” - Euroecolab, Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Sos. Fundeni 258, 022328 Bucharest, Romania
| | | | - Kevin F Fox
- Department of Cardiology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, UK
| | - Bernard Cosyns
- Department of Cardiology, Centrum voor Hart en vaatziekten (CHVZ), Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2300RC, The Netherlands
| | | | - Erwan Donal
- Service de Cardiologie Et Maladies Vasculaires Et CIC-IT 1414, CHU Rennes, 35000 Rennes, France
- Université de Rennes 1, LTSI, 35000 Rennes, France
| | - Frank A Flachskampf
- Department of Medical Sciences, Uppsala University, Clinical Physiology and Cardiology, Uppsala University Hospital, Uppsala, Sweden
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Anthea Hospital, Bari, Italy
| | - Denisa Muraru
- Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, P.le Brescia 201, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Leyla Elif Sade
- Department of Cardiology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Thor Edvardsen
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway
- Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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53
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Veldtman GR, Pirisi M, Storti E, Roomi A, Fadl-Elmula FEM, Vriz O, Bokhari S, Ammash N, Salam Y, Liu GZ, Spinelli S, Barbieri G, Hashmi S. Management principles in patients with COVID-19: perspectives from a growing global experience with emphasis on cardiovascular surveillance. Open Heart 2020; 7:openhrt-2020-001357. [PMID: 33168640 PMCID: PMC7653968 DOI: 10.1136/openhrt-2020-001357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/07/2020] [Accepted: 08/19/2020] [Indexed: 12/16/2022] Open
Abstract
The COVID-19, due to SARS-CoV-2, has uncovered many real-world issues when it comes to healthcare management and has led to a widespread mortality. Observations thus far from the reports of COVID-19 have indicated that certain risk groups for example, those with pre-existing cardiovascular (CV) disease, hypertension, diabetes, chronic kidney disease and tobacco use are prone to disease development and specifically development of severe disease and possible fatality. It is increasingly evident that many CV conditions occur frequently. These include myopericarditis, acute coronary syndromes, thrombosis, arrhythmias, hypertension and heart failure. Many professional organisations and societies related to cardiology have produced guidelines or recommendations on most of the above-mentioned aspects. Given these rapid developments, the aims of this review manuscript were to summarise and integrate recent publications with newly developed guidelines and with the first-hand experience of frontline physicians and to yield a pragmatic insight and approach to CV complications of COVID-19. We emphasise on a strategic tier-based approach for initial assessment and management of COVID-19, and then delve into focused areas within CV domains, and additionally highlighting the role of point-of-care ultrasound especially lung ultrasound, echocardiography and electrocardiography, in the management of these patients. We hope this paper will serve as a useful tool in the CV management of COVID-19 for clinicians practicing in both developing and developed countries.
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Affiliation(s)
- Gruschen R Veldtman
- Adolescent and Adult Congenital Heart Disease Program, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Novara, Italy
| | - Enrico Storti
- Department of Critical Care, Maggiore Hospital, Lodi, Lodi, Italy
| | - Asad Roomi
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Riyadh, Saudi Arabia
| | - Fadl Elmula M Fadl-Elmula
- Cardiology, Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Riyadh, Saudi Arabia
| | - Olga Vriz
- Cardiology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | - Naser Ammash
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yezan Salam
- College of Medicine, Alfaisal University, Riyadh, Riyadh Province, Saudi Arabia
| | - Guang Zong Liu
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, Harbin, China
| | - Stefano Spinelli
- Emergency Medicine Unit, Pisa University Hospital, Pisa, Toscana, Italy
| | - Greta Barbieri
- Emergency Medicine Unit, Pisa University Hospital, Pisa, Toscana, Italy
| | - Shahrukh Hashmi
- Clinical Trials Unit, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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54
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Kiefl D, Eisenmann S, Michels G, Schmid M, Ludwig C, Pin M, Glöckner E, Petersen PF, Damjanovic D, Schellhaas S, Janssens U, Fandler M, Blaschke S, Geuting M, Müller T, Menzel J, Heinzmann A, Helm M, Dinse-Lambracht A, Bernhard M, Spethmann S, Stock KF, Clevert DA, Breitkreutz R. [German recommendations on lung and thoracic ultrasonography in patients with COVID-19]. Med Klin Intensivmed Notfmed 2020; 115:654-667. [PMID: 33044655 PMCID: PMC7548535 DOI: 10.1007/s00063-020-00740-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023]
Abstract
Lung and chest ultrasound are further examination modalities in addition to computed tomography and laboratory diagnostics in patients with COVID-19. It extends the clinical-physical examination because it can examine lung surface sensitively. Lung surface pattern changes have been found in sonograms of patients with COVID-19 pneumonia and during the course of the disease. German specialist societies of clinical acute, emergency and intensive care medicine as well as imaging, which are concerned with the care of patients with SARS-CoV‑2 infection and COVID-19, have coordinated recommendations for lung and thorax sonography. This document has been created within a transparent process, led by the German Society of Interdisciplinary Emergency and Acute Medicine e. V. (DGINA), and worked out by an expert panel and delegates from the societies. Sources of the first 200 cases were summarized. Typical thorax sonographic findings are presented. International sources or standards that were available in PubMed until May 24, 2020 were included. Using case studies and multimedia content, the document is intended to not only support users but also demonstrate quality features and the potential of chest and lung sonography. The German Society for Ultrasound in Medicine (DEGUM) is carrying out a multicenter study (study coordination at the TU Munich).
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Affiliation(s)
- Daniel Kiefl
- Klinik für Interdisziplinäre Notfallmedizin, Sana Klinikum Offenbach GmbH, Starkenburgring 66, 63069, Offenbach am Main, Deutschland.
| | - Stephan Eisenmann
- Schwerpunkt Pneumologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Mathias Schmid
- Klinik für Gastroenterologie, Pneumologie, Internistische Akut- und Intensivmedizin, München Klinik Harlaching, München, Deutschland
| | - Corinna Ludwig
- Klinik für Thoraxchirurgie, Florence-Nightingale-Krankenhaus der Kaiserswerther Diakonie, Düsseldorf, Deutschland
| | - Martin Pin
- Zentrale interdisziplinäre Notaufnahme und Aufnahmebereich, Florence-Nightingale-Krankenhaus der Kaiserswerther Diakonie, Düsseldorf, Deutschland
| | - Erika Glöckner
- Klinik für Gastroenterologie, Endokrinologie und Zentrale Notaufnahme Nord, Klinikum Nürnberg Nord, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | | | - Domagoj Damjanovic
- Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Freiburg, Deutschland
| | | | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Martin Fandler
- Interdisziplinäre Notaufnahme, Klinikum Bamberg, Bamberg, Deutschland
| | - Sabine Blaschke
- Interdisziplinäre Notaufnahme, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Markus Geuting
- Abteilung Anästhesie, Vulpius Klinik, Bad Rappenau, Deutschland
| | - Thomas Müller
- Medizinische Klinik II, St. Josefs-Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
| | - Joseph Menzel
- DEGUM Kursleiter Innere Medizin, Endosonographie, Medizinische Klinik II, Klinikum Ingolstadt, Ingolstadt, Deutschland
| | | | - Matthias Helm
- Abteilung X (Anästhesie), Bundeswehrkrankenhaus, Ulm, Deutschland
| | - Alexander Dinse-Lambracht
- Interdisziplinäres Notfallzentrum, Trägergesellschaft Kliniken Aurich-Emden-Norden, Aurich-Emden-Norden, Deutschland
| | - Michael Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Sebastian Spethmann
- Medizinische Klinik A, Kardiologie, Angiologie, Nephrologie, internistische Intensivmedizin, Medizinische Hochschule Brandenburg, Campus Ruppiner Kliniken, Neuruppin, Deutschland
| | - Konrad F Stock
- Nephrologisches Ultraschalllabor, TU München, München, Deutschland
| | - Dirk-André Clevert
- Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschallzentrum, Universität München, Klinikum Großhadern, München, Deutschland
| | - Raoul Breitkreutz
- Fachbereich/Institut f. Gesundheit & Soziales (IfGS), FOM Hochschule für Ökonomie & Management, Franklinstr. 52, 60486, Frankfurt am Main, Deutschland.
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Waweru-Siika W, Barasa A, Wachira B, Nekyon D, Karau B, Juma F, Wanjiku G, Otieno H, Bloomfield GS, Sloth E. Building focused cardiac ultrasound capacity in a lower middle-income country: A single centre study to assess training impact. Afr J Emerg Med 2020; 10:136-143. [PMID: 32923324 PMCID: PMC7474241 DOI: 10.1016/j.afjem.2020.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/14/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022] Open
Abstract
Background In low- and middle-income countries (LMICs) where echocardiography experts are in short supply, training non-cardiologists to perform Focused Cardiac Ultrasound (FoCUS) could minimise diagnostic delays in time-critical emergencies. Despite advocacy for FoCUS training however, opportunities in LMICs are limited, and the impact of existing curricula uncertain. The aim of this study was to assess the impact of FoCUS training based on the Focus Assessed Transthoracic Echocardiography (FATE) curriculum. Our primary objective was to assess knowledge gain. Secondary objectives were to evaluate novice FoCUS image quality, assess inter-rater agreement between expert and novice FoCUS and identify barriers to the establishment of a FoCUS training programme locally. Methods This was a pre-post quasi-experimental study at a tertiary hospital in Nairobi, Kenya. Twelve novices without prior echocardiography training underwent FATE training, and their knowledge and skills were assessed. Pre- and post-test scores were compared using the Wilcoxon signed-rank test to establish whether the median of the difference was different than zero. Inter-rater agreement between expert and novice scans was assessed, with a Cohen's kappa >0.6 indicative of good inter-rater agreement. Results Knowledge gain was 37.7%, with a statistically significant difference between pre-and post-test scores (z = 2.934, p = 0.001). Specificity of novice FoCUS was higher than sensitivity, with substantial agreement between novice and expert scans for most FoCUS target conditions. Overall, 65.4% of novice images were of poor quality. Post-workshop supervised practice was limited due to scheduling difficulties. Conclusions Although knowledge gain is high following a brief training in FoCUS, image quality is poor and sensitivity low without adequate supervised practice. Substantial agreement between novice and expert scans occurs even with insufficient practice when the prevalence of pathology is low. Supervised FoCUS practice is challenging to achieve in a real-world setting in LMICs, undermining the effectiveness of training initiatives.
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Affiliation(s)
- Wangari Waweru-Siika
- Department of Anaesthesia, Aga Khan University, Nairobi, Kenya
- Corresponding author.
| | - Anders Barasa
- Department of Medicine, Aga Khan University, Nairobi, Kenya
- Department of Cardiology, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Benjamin Wachira
- Department of Emergency Medicine, Aga Khan University, Nairobi, Kenya
| | - David Nekyon
- Department of Anaesthesia, Aga Khan University, Nairobi, Kenya
| | - Barbara Karau
- Department of Medicine, Aga Khan University, Nairobi, Kenya
| | - Fatimah Juma
- Department of Medicine, Aga Khan University, Nairobi, Kenya
| | - Grace Wanjiku
- Section of Global Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Harun Otieno
- Department of Medicine, Aga Khan University, Nairobi, Kenya
| | - Gerald S. Bloomfield
- Duke Clinical Research Institute, Duke Global Health Institute, Department of Medicine, Duke University, Durham, NC, USA
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Gargani L, Soliman-Aboumarie H, Volpicelli G, Corradi F, Pastore MC, Cameli M. Why, when, and how to use lung ultrasound during the COVID-19 pandemic: enthusiasm and caution. Eur Heart J Cardiovasc Imaging 2020; 21:941-948. [PMID: 32515793 PMCID: PMC7314093 DOI: 10.1093/ehjci/jeaa163] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Hatem Soliman-Aboumarie
- Department of Anaesthesia and Critical Care', Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Francesco Corradi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy.,Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Via Mura delle Cappuccine 14, Genova, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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Chieffo A, Stefanini GG, Price S, Barbato E, Tarantini G, Karam N, Moreno R, Buchanan GL, Gilard M, Halvorsen S, Huber K, James S, Neumann FJ, Möllmann H, Roffi M, Tavazzi G, Ferré JM, Windecker S, Dudek D, Baumbach A. EAPCI Position Statement on Invasive Management of Acute Coronary Syndromes during the COVID-19 pandemic. EUROINTERVENTION 2020; 16:233-246. [PMID: 32404302 DOI: 10.4244/eijy20m05_01] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic poses an unprecedented challenge to healthcare worldwide. The infection can be life threatening and require intensive care treatment. The transmission of the disease poses a risk to both patients and healthcare workers. The number of patients requiring hospital admission and intensive care may overwhelm health systems and negatively affect standard care for patients presenting with conditions needing emergency interventions. This position statements aims to assist cardiologists in the invasive management of acute coronary syndrome (ACS) patients in the context of the COVID-19 pandemic. To that end, we assembled a panel of interventional cardiologists and acute cardiac care specialists appointed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and from the Acute Cardiovascular Care Association (ACVC) and included the experience from the first and worst affected areas in Europe. Modified diagnostic and treatment algorithms are proposed to adapt evidence-based protocols for this unprecedented challenge. Various clinical scenarios, as well as management algorithms for patients with a diagnosed or suspected COVID-19 infection, presenting with ST- and non-ST-segment elevation ACS are described. In addition, we address the need for re-organization of ACS networks, with redistribution of hub and spoke hospitals, as well as for in-hospital reorganization of emergency rooms and cardiac units, with examples coming from multiple European countries. Furthermore, we provide a guidance to reorganization of catheterization laboratories and, importantly, measures for protection of healthcare providers involved with invasive procedures.
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Affiliation(s)
- Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
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Edvardsen T. Focused cardiac ultrasound examination is ready for use as a diagnostic tool of acute aortic syndromes in the emergency room. Eur Heart J 2020; 40:1961-1962. [PMID: 31162537 DOI: 10.1093/eurheartj/ehz356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
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59
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Lin A, Kolossváry M, Išgum I, Maurovich-Horvat P, Slomka PJ, Dey D. Artificial intelligence: improving the efficiency of cardiovascular imaging. Expert Rev Med Devices 2020; 17:565-577. [PMID: 32510252 PMCID: PMC7382901 DOI: 10.1080/17434440.2020.1777855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 06/01/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Artificial intelligence (AI) describes the use of computational techniques to mimic human intelligence. In healthcare, this typically involves large medical datasets being used to predict a diagnosis, identify new disease genotypes or phenotypes, or guide treatment strategies. Noninvasive imaging remains a cornerstone for the diagnosis, risk stratification, and management of patients with cardiovascular disease. AI can facilitate every stage of the imaging process, from acquisition and reconstruction, to segmentation, measurement, interpretation, and subsequent clinical pathways. AREAS COVERED In this paper, we review state-of-the-art AI techniques and their current applications in cardiac imaging, and discuss the future role of AI as a precision medicine tool. EXPERT OPINION Cardiovascular medicine is primed for scalable AI applications which can interpret vast amounts of clinical and imaging data in greater depth than ever before. AI-augmented medical systems have the potential to improve workflow and provide reproducible and objective quantitative results which can inform clinical decisions. In the foreseeable future, AI may work in the background of cardiac image analysis software and routine clinical reporting, automatically collecting data and enabling real-time diagnosis and risk stratification.
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Affiliation(s)
- Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ivana Išgum
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Piotr J Slomka
- Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
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Skulstad H, Cosyns B, Popescu BA, Galderisi M, Salvo GD, Donal E, Petersen S, Gimelli A, Haugaa KH, Muraru D, Almeida AG, Schulz-Menger J, Dweck MR, Pontone G, Sade LE, Gerber B, Maurovich-Horvat P, Bharucha T, Cameli M, Magne J, Westwood M, Maurer G, Edvardsen T. COVID-19 pandemic and cardiac imaging: EACVI recommendations on precautions, indications, prioritization, and protection for patients and healthcare personnel. Eur Heart J Cardiovasc Imaging 2020; 21:592-598. [PMID: 32242891 PMCID: PMC7184341 DOI: 10.1093/ehjci/jeaa072] [Citation(s) in RCA: 201] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Helge Skulstad
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bernard Cosyns
- Centrum voor Hart en Vaatziekten (CHVZ), Universitair Ziekenhuis Brussel, Vrij Universiteit van Brussel, Brussels, Belgium
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bucharest, Romania
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | | | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
| | - Steffen Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | | | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ana G Almeida
- Cardiology, University Hospital Santa Maria /CHLN, CCUL, Faculty of Medicine of Lisbon University, Lisbon, Portugal
| | - Jeanette Schulz-Menger
- Charité Medical Faculty of the Humboldt University Berlin, ECRC, Berlin, Germany.,DZHK, Partner site, Berlin, Germany.,Helios Clinics Berlin-Buch, Cardiology, Berlin, Germany
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Leyla Elif Sade
- Department of Cardiology, University of Baskent, Ankara, Turkey
| | - Bernhard Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | | | - Tara Bharucha
- Department of Congenital Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, France.,INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, GEIST, 2, Limoges, France
| | - Mark Westwood
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Gerald Maurer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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Chieffo A, Stefanini GG, Price S, Barbato E, Tarantini G, Karam N, Moreno R, Buchanan GL, Gilard M, Halvorsen S, Huber K, James S, Neumann FJ, Möllmann H, Roffi M, Tavazzi G, Mauri Ferré J, Windecker S, Dudek D, Baumbach A. EAPCI Position Statement on Invasive Management of Acute Coronary Syndromes during the COVID-19 pandemic. Eur Heart J 2020; 41:1839-1851. [PMID: 32405641 PMCID: PMC7239193 DOI: 10.1093/eurheartj/ehaa381] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/15/2020] [Accepted: 05/06/2020] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic poses an unprecedented challenge to healthcare worldwide. The infection can be life threatening and require intensive care treatment. The transmission of the disease poses a risk to both patients and healthcare workers. The number of patients requiring hospital admission and intensive care may overwhelm health systems and negatively affect standard care for patients presenting with conditions needing emergency interventions. This position statements aims to assist cardiologists in the invasive management of acute coronary syndrome (ACS) patients in the context of the COVID-19 pandemic. To that end, we assembled a panel of interventional cardiologists and acute cardiac care specialists appointed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and from the Acute Cardiovascular Care Association (ACVC) and included the experience from the first and worst affected areas in Europe. Modified diagnostic and treatment algorithms are proposed to adapt evidence-based protocols for this unprecedented challenge. Various clinical scenarios, as well as management algorithms for patients with a diagnosed or suspected COVID-19 infection, presenting with ST- and non-ST-segment elevation ACS are described. In addition, we address the need for re-organization of ACS networks, with redistribution of hub and spoke hospitals, as well as for in-hospital reorganization of emergency rooms and cardiac units, with examples coming from multiple European countries. Furthermore, we provide a guidance to reorganization of catheterization laboratories and, importantly, measures for protection of healthcare providers involved with invasive procedures.
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Affiliation(s)
- Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Emanuele Barbato
- Department of Advanced Biomedical Sciences University Federico II, Naples, Italy
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Nicole Karam
- European Hospital Georges Pompidou (Cardiology Department) and University of Paris, Paris, France
| | - Raul Moreno
- Cardiology Department, Hospital La Paz and IDIPAZ, Madrid, Spain
| | - Gill Louise Buchanan
- Department of Cardiology, North Cumbria Integrated Care NHS Foundation Trust, Cumbria, UK
| | - Martine Gilard
- Service de Cardiologie, Brest University Hospital, Brest, France
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, and University of Oslo, Oslo, Norway
| | - Kurt Huber
- 3Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, and Sigmund Freud University, Medical School, Vienna, Austria
| | - Stefan James
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Sweden
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II University Heart Centre Freiburg, Bad Krozingen, Germany
| | - Helge Möllmann
- Department of Cardiology St.-Johannes-Hospital Klinik für Innere Medizin I, Dortmund, Germany
| | - Marco Roffi
- Division of Cardiology, University Hospitals, Geneva, Switzerland
| | - Guido Tavazzi
- Department of clinical-surgical, diagnostic and pediatric sciences, Unit of anaesthesia and intensive care, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
| | | | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland and Maria Cecilia Hospital GVM, Cotignola, Ravenna, Italy
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, Barts Heart Centre, London, UK and Yale University School of Medicine, New Haven, CT, USA
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62
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Montrief T, Bridwell RE, Koyfman A, Simon E, Long B. The authors respond: Ultrasound assessment in pulmonary hypertension. Am J Emerg Med 2020; 38:1024-1025. [DOI: 10.1016/j.ajem.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022] Open
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Emergency bedside ultrasound-benefits as well as caution: Part 2: Echocardiography. Curr Opin Crit Care 2020; 25:605-612. [PMID: 31567518 DOI: 10.1097/mcc.0000000000000674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Critical care echocardiography (CCE) has become an important component of general critical care ultrasonography, and a current review of its performance is presented. RECENT FINDINGS Basic CCE should be performed as a goal-directed examination to better identify specific signs and to answer important clinical questions concerning acute hemodynamic concerns. It has evolved in the ICU and also in the emergency department not only for improved diagnostic capability but also as an effective part of the triage process. It remains an efficacious procedure even in patients with respiratory failure when combined with lung ultrasonography. Numerous acronyms were proposed, but in all cases, CCE responds to the same rules as fundamental echocardiography. Basic CCE requires accessible and comprehensive training for physicians and is mandatory for all intensivists. Development of pocket echo devices may increase the use of basic CCE as has miniaturization of other medical technologies. Performance should be managed by guidelines, and the CCE training program should be standardized worldwide. More trials are welcome to evaluate its impact on patient outcomes. SUMMARY Thanks to its ability to quickly obtain a diagnostic orientation at the bedside and to implement targeted therapy, basic CCE over the past decade has become an essential tool for hemodynamic assessment of the cardiopulmonary unstable patient. Its more recent incorporation into the education of trainees in medical school and residencies/fellowships has reinforced its perceived importance in critical care management, despite the relative paucity as yet of rigorous scientific evidence demonstrating positive outcome modification from its use.
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Aslaner MA, Yamanoğlu A. A letter to the editor: Evaluation and management of pulmonary hypertension in the emergency department setting. Am J Emerg Med 2020; 38:1023-1024. [PMID: 32201067 DOI: 10.1016/j.ajem.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Mehmet Ali Aslaner
- Department of Emergency Medicine, Gazi University School of Medicine, Ankara, Turkey.
| | - Adnan Yamanoğlu
- Department of Emergency Medicine, İzmir Katip Çelebi University Atatürk Education and Research Hospital, İzmir, Turkey
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65
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Arystan AZ, Khamzina YT, Benberin VV, Fettser DV, Belenkov YN. [Lung Ultrasound: new Opportunities for a Cardiologist]. KARDIOLOGIIA 2020; 60:81-92. [PMID: 32245358 DOI: 10.18087/cardio.2020.1.n617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/13/2019] [Accepted: 09/17/2019] [Indexed: 06/11/2023]
Abstract
This review focused on ultrasound examination of lungs, a useful complement to transthoracic echocardiography (EchoCG), which is superior to chest X-ray in the diagnostic value. The lung acoustic window always remains open and allows obtaining high-quality images in most cases. For a cardiologist, the major points of the method application are determination of pleural effusion and lung congestion. This method has a number of advantages: it is time-saving; cost-effective; portable and accessible; can be used in a real-time mode; not associated with radiation; reproducible; and highly informative. The ultrasound finding of wet lungs would indicate threatening, acute cardiac decompensation long before appearance of clinical, auscultative, and radiological signs of lung congestion. Modern EchoCG should include examination of the heart and lungs as a part of a single, integrative ultrasound examination.
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Affiliation(s)
- A Z Arystan
- Medical Centre Hospital of the President's Affairs Administration of the Republic of Kazakhstan
| | - Y T Khamzina
- Medical Centre Hospital of the President's Affairs Administration of the Republic of Kazakhstan
| | - V V Benberin
- Medical Centre Hospital of the President's Affairs Administration of the Republic of Kazakhstan
| | - D V Fettser
- Municipal Clinical Hospital #52 at the Health Care Department of Moscow City
| | - Y N Belenkov
- I.M. Sechenov First Moscow State Medical University
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66
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Koster G, Kaufmann T, Hiemstra B, Wiersema R, Vos ME, Dijkhuizen D, Wong A, Scheeren TWL, Hummel YM, Keus F, van der Horst ICC. Feasibility of cardiac output measurements in critically ill patients by medical students. Ultrasound J 2020; 12:1. [PMID: 31912438 PMCID: PMC6946766 DOI: 10.1186/s13089-020-0152-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 01/01/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Critical care ultrasonography (CCUS) is increasingly applied also in the intensive care unit (ICU) and performed by non-experts, including even medical students. There is limited data on the training efforts necessary for novices to attain images of sufficient quality. There is no data on medical students performing CCUS for the measurement of cardiac output (CO), a hemodynamic variable of importance for daily critical care. OBJECTIVE The aim of this study was to explore the agreement of cardiac output measurements as well as the quality of images obtained by medical students in critically ill patients compared to the measurements obtained by experts in these images. METHODS In a prospective observational cohort study, all acutely admitted adults with an expected ICU stay over 24 h were included. CCUS was performed by students within 24 h of admission. CCUS included the images required to measure the CO, i.e., the left ventricular outflow tract (LVOT) diameter and the velocity time integral (VTI) in the LVOT. Echocardiography experts were involved in the evaluation of the quality of images obtained and the quality of the CO measurements. RESULTS There was an opportunity for a CCUS attempt in 1155 of the 1212 eligible patients (95%) and in 1075 of the 1212 patients (89%) CCUS examination was performed by medical students. In 871 out of 1075 patients (81%) medical students measured CO. Experts measured CO in 783 patients (73%). In 760 patients (71%) CO was measured by both which allowed for comparison; bias of CO was 0.0 L min-1 with limits of agreement of - 2.6 L min-1 to 2.7 L min-1. The percentage error was 50%, reflecting poor agreement of the CO measurement by students compared with the experts CO measurement. CONCLUSIONS Medical students seem capable of obtaining sufficient quality CCUS images for CO measurement in the majority of critically ill patients. Measurements of CO by medical students, however, had poor agreement with expert measurements. Experts remain indispensable for reliable CO measurements. Trial registration Clinicaltrials.gov; http://www.clinicaltrials.gov; registration number NCT02912624.
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Affiliation(s)
- Geert Koster
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Thomas Kaufmann
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bart Hiemstra
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Renske Wiersema
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Madelon E. Vos
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Devon Dijkhuizen
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Adrian Wong
- Department of Anaesthesia and Intensive Care, Royal Surrey Hospital, Guildford, UK
| | - Thomas W. L. Scheeren
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yoran M. Hummel
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederik Keus
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Iwan C. C. van der Horst
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
- Department of Intensive Care, Maastricht University Medical Center+, University Maastricht, Maastricht, The Netherlands
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67
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Cosyns B, Haugaa KH, Gerber BL, Gimelli A, Donal E, Maurer G, Edvardsen T. The year 2018 in the European Heart Journal-Cardiovascular Imaging: Part II. Eur Heart J Cardiovasc Imaging 2019; 20:1337-1344. [PMID: 31750534 DOI: 10.1093/ehjci/jez218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 09/10/2019] [Indexed: 01/12/2023] Open
Abstract
European Heart Journal - Cardiovascular Imaging was launched in 2012 as a multimodality cardiovascular imaging journal. It has gained an impressive impact factor during its first 5 years and is now established as one of the top cardiovascular journals and has become the most important cardiovascular imaging journal in Europe. The most important studies from 2018 will be highlighted in two reports. Part I of the review has focused on studies about myocardial function and risk prediction, myocardial ischaemia, and emerging techniques in cardiovascular imaging, while Part II will focus on cardiomyopathies, congenital heart diseases, valvular heart diseases, and heart failure.
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Affiliation(s)
- Bernard Cosyns
- Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel, 109 Laarbeeklaan, Brussels, Belgium
| | - Kristina H Haugaa
- Department of Cardiology, Centre of Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate 10/2806, Brussels, Belgium
| | | | - Erwan Donal
- Cardiology and CIC-IT1414, CHU Rennes, Rennes, France.,LTSI INSERM 1099, University Rennes-1, Rennes, France
| | - Gerald Maurer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thor Edvardsen
- Department of Cardiology, Centre of Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
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68
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69
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Bettseitige echokardiographische Evaluation der diastolischen Funktion. Med Klin Intensivmed Notfmed 2019; 114:499-503. [DOI: 10.1007/s00063-019-0556-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/07/2019] [Indexed: 11/26/2022]
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70
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Edvardsen T, Haugaa KH, Petersen SE, Gimelli A, Donal E, Maurer G, Popescu BA, Cosyns B. The year 2018 in the European Heart Journal - Cardiovascular Imaging: Part I. Eur Heart J Cardiovasc Imaging 2019; 20:858-865. [PMID: 31211353 DOI: 10.1093/ehjci/jez133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/17/2019] [Indexed: 12/18/2022] Open
Abstract
The European Heart Journal - Cardiovascular Imaging has become one of the leading multimodality cardiovascular imaging journal, since it was launched in 2012. The impact factor is an impressive 8.366 and it is now established as one of the top 10 cardiovascular journals. The journal is the most important cardiovascular imaging journal in Europe. The most important studies from 2018 will be highlighted in two reports. Part I of the review will focus on studies about myocardial function and risk prediction, myocardial ischaemia, and emerging techniques in cardiovascular imaging, while Part II will focus on valvular heart disease, heart failure, cardiomyopathies, and congenital heart disease.
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Affiliation(s)
- Thor Edvardsen
- Department of Cardiology, Centre of Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Nydalen, Sognsvannsveien 20, NO-0424Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Sognsvannsveien 20, Oslo, Norway
| | - Kristina H Haugaa
- Department of Cardiology, Centre of Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Nydalen, Sognsvannsveien 20, NO-0424Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Sognsvannsveien 20, Oslo, Norway
| | - Steffen E Petersen
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, UK
| | - Alessia Gimelli
- Fondazione Toscana/CNR G. Monasterio, Via Moruzzi 1, Pisa, Italy
| | - Erwan Donal
- Cardiology Department and CIC-IT1414, CHU Rennes, 6 Rue H Le Guillou, Rennes, France.,LTSI INSERM 1099, University Rennes-1, Rue H Le Guillou, Rennes, France
| | - Gerald Maurer
- Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Wien, Austria
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Department of Cardiology, Emergency Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, Sector 2, Bucharest, Romania
| | - Bernard Cosyns
- Department of Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair Ziekenhuis Brussel, 109 Laarbeeklaan, Brussels, Belgium
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71
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Savino K, Ambrosio G. Handheld Ultrasound and Focused Cardiovascular Echography: Use and Information. ACTA ACUST UNITED AC 2019; 55:medicina55080423. [PMID: 31370289 PMCID: PMC6722573 DOI: 10.3390/medicina55080423] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 12/23/2022]
Abstract
The availability of miniaturized ultrasound machines has changed our approach to many cardiovascular diseases. Handheld ultrasound imaging can be performed at the bedside, it is easy to use, and the information provided, although limited, is of unquestionable importance for a quick diagnosis that leads to early treatment. They have unique characteristics: Low cost, wide availability, safety, accuracy, and can be used in different clinical scenarios and by operators with different backgrounds. Image acquisition and interpretation is rapid and provides, in each situation, useful information for diagnosis, prognosis, and clinical and therapeutic management. This review focuses on the use of handheld ultrasound devices, describes differences with other equipment, their limitations, and the numerous advantages derived from their use.
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Affiliation(s)
- Ketty Savino
- Cardiology University of Perugia, 06156 Perugia, Italy.
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72
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Cardim N, Dalen H, Voigt JU, Ionescu A, Price S, Neskovic AN, Edvardsen T, Galderisi M, Sicari R, Donal E, Stefanidis A, Delgado V, Zamorano J, Popescu BA. The use of handheld ultrasound devices: a position statement of the European Association of Cardiovascular Imaging (2018 update). Eur Heart J Cardiovasc Imaging 2019; 20:245-252. [PMID: 30351358 DOI: 10.1093/ehjci/jey145] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 12/19/2022] Open
Abstract
Recent technological advances in echocardiography, with progressive miniaturization of ultrasound machines, have led to the development of handheld ultrasound devices (HUD). These devices, no larger than some mobile phones, can be used to perform partial, focused exams as an extension to the physical examination. The European Association of Cardiovascular Imaging (EACVI) acknowledges that the dissemination of appropriate HUD use is inevitable and desirable, because of its potential impact on patient management. However, as a scientific society of cardiac imaging, our role is to provide guidance in order to optimize patient benefit and minimize drawbacks from inappropriate use of this technology. This document provides updated recommendations for the use of HUD, including nomenclature, appropriateness, indications, operators, clinical environments, data management and storage, educational needs, and training of potential users. It also addresses gaps in evidence, controversial issues, and future technological developments.
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Affiliation(s)
- Nuno Cardim
- Cardiology Department, Hospital da Luz, Av. Lusíada, n° 100, Lisbon, Portugal.,Faculdade Ciências Médicas da Universidade nova de Lisboa, Campo Mártires da Pátria 130, Lisbon, Portugal
| | - Havard Dalen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiology, St. Olav's University Hospital, Trondheim, Norway.,Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Adrian Ionescu
- Morriston Cardiac Regional Centre, ABMU LHB, Swansea, UK
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, UK
| | - Alexsandar N Neskovic
- Department of Cardiology, Clinical Hospital Center Zemun, Vukova 9, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Thor Edvardsen
- Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet and University of Oslo, Sognsvannsveien 20, Oslo, Norway
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, VIa S. Pansini 5, Napples, Italy
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, Pisa, Italy
| | - Erwan Donal
- Service de Cardiologie et CIC-IT INSERM 1414, CHU Pontchaillou, Rennes, France.,LTSI, Université de Rennes 1, INSERM, UMR, Rennes, France
| | | | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden, The Netherlands
| | - Jose Zamorano
- Department of Cardiology, Hospital Ramón y Cajal, Ctra. de Colmenar Viejo, km. 9, 100, Madrid, Spain.,CIBERV, Madrid, Spain
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila", Euroecolab, Institute of cardiovascular diseases "Prof. Dr. C C Iliescu, Bucharest, Romania
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73
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Evaluation of the efficacy of a self-training programme in focus cardiac ultrasound with simulator. Arch Cardiovasc Dis 2019; 112:576-584. [PMID: 31350012 DOI: 10.1016/j.acvd.2019.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/26/2019] [Accepted: 06/12/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Focus cardiac ultrasound is a great tool for quick evaluation of cardiac function in acute settings with limited time and expertise in echocardiography. Adequate training is essential for physicians willing to use this imaging technique. AIM The goal of this study was to assess the efficacy of a self-training programme using a cardiac ultrasound simulator. METHODS Thirty-five trainees in cardiology, emergency medicine or anaesthesiology entered the programme, which started with an e-learning lecture on focus cardiac ultrasound, with practice on a simulator, followed by implementation on patients, and ended with self-training in image analysis on an online platform. A post-test evaluation was carried out at the end of the theoretical training, followed by a final live evaluation on patients (timed acquisition of the five reference views used in focus cardiac ultrasound, grading each view on a scale of 1 to 5). Trainees were also evaluated online regarding their interpretation of 20 video clips. RESULTS The median (interquartile range) interpretability scores following simulator training were 5 (4-5) for the parasternal long-axis view, 5 (4-5) for the apical four-chamber view, and 4 (4-5) for the subcostal window. Interpretability was significantly inferior in the live evaluation compared with the post-test evaluation, except for the parasternal long-axis and subcostal views. The mean score for the video clips (out of 20) was 14.5±2.4. CONCLUSIONS After a short self-training programme, trainees were able to acquire the main views of focus cardiac ultrasound with sufficient quality and in a short time period.
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74
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Spencer KT, Flachskampf FA. Focused Cardiac Ultrasonography. JACC Cardiovasc Imaging 2019; 12:1243-1253. [DOI: 10.1016/j.jcmg.2018.12.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 12/28/2018] [Indexed: 11/30/2022]
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75
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A practical approach to critical care ultrasound. J Crit Care 2019; 51:156-164. [DOI: 10.1016/j.jcrc.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/06/2019] [Accepted: 01/07/2019] [Indexed: 12/22/2022]
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76
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Vieillard-Baron A, Millington SJ, Sanfilippo F, Chew M, Diaz-Gomez J, McLean A, Pinsky MR, Pulido J, Mayo P, Fletcher N. A decade of progress in critical care echocardiography: a narrative review. Intensive Care Med 2019; 45:770-788. [DOI: 10.1007/s00134-019-05604-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/14/2019] [Indexed: 12/12/2022]
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77
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Baron A, Beirne G, Wald A. Paramedic point of care ultrasound at Australian mass gatherings. Australas J Ultrasound Med 2019; 22:56-60. [PMID: 34760538 PMCID: PMC8411800 DOI: 10.1002/ajum.12132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Point of care ultrasound (POCUS) is not traditionally performed by paramedics, and where it is used, is generally limited to resuscitative-type ultrasound examinations. We describe a select series of patient care cases collected between August 2017 and February 2018 which are the first known examples of expanded POCUS performed by a paramedic in this context. These point of care scans were performed for both high and lower acuity patient presentations and are felt to have contributed to improved decision-making in the treatment and onward referral of patients in the Australian festival and event medicine.
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Affiliation(s)
- Aidan Baron
- Paramedic Ultrasound Research GroupSydneyAustralia
- Emergency Cardiovascular and Critical Care Research GroupCentre for Health and Social Care ResearchKingston University and St George's University of LondonLondonUK
- Discipline of ParamedicineSchool of Biomedical SciencesFaculty of ScienceCharles Sturt UniversityAlburyNew South WalesAustralia
| | | | - Anthony Wald
- Paramedic Ultrasound Research GroupSydneyAustralia
- Monash Cardiovascular Research CentreMonashHeartMonash Medical CentreMelbourneVictoriaAustralia
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Consensus on focused cardiac ultrasound: The beginning of a promising friendship. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2018.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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79
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Torres Macho J, Zapatero Gaviria A, García de Casasola G. Consenso sobre ecocardioscopia: el comienzo de una prometedora amistad. Rev Clin Esp 2019; 219:57-58. [DOI: 10.1016/j.rce.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
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80
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Fox K, Achenbach S, Bax J, Cosyns B, Delgado V, Dweck MR, Edvardsen T, Flachskampf F, Habib G, Lancellotti P, Muraru D, Neglia D, Pontone G, Schwammenthal E, Sechtem U, Westwood M, Popescu BA. Multimodality imaging in cardiology: a statement on behalf of the Task Force on Multimodality Imaging of the European Association of Cardiovascular Imaging. Eur Heart J 2018; 40:553-558. [DOI: 10.1093/eurheartj/ehy669] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/04/2018] [Indexed: 02/07/2023] Open
Affiliation(s)
- Kevin Fox
- Department of Cardiology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, UK
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Faculty of Medicine, Krankenhausstraße 12, Erlangen, Germany
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Bernard Cosyns
- Cardiology Department, CHVZ (Centrum voor Hart en Vaatziekten) - Universtair Ziekhenhuis Brussel, 101 Laarbeklaan, Brussels, Belgium
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Thor Edvardsen
- Oslo University Hospital, Department of Cardiology, Rikshospitalet and University of Oslo Sognsvannsveien 20, Oslo, Norway
| | - Frank Flachskampf
- Department of Medical Sciences, Uppsala University, Clinical Physiology and Cardiology, Akademiska, Uppsala, Sweden
| | - Gilbert Habib
- APHM, La Timone Hospital, Cardiology Department, Rue Saint-Pierre, Marseille Cedex 5, France
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, 27 Boulevard Jean Moulin, Marseille, CEDEX 5, France
| | - Patrizio Lancellotti
- University of Liège Hospital, Department of Cardiology, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, VIA C. ROSALBA, Bari, Italy
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, Padua, Italy
| | - Danilo Neglia
- Fondazione Toscana G. Monasterio (FTGM), Cardiovascular Department, Via Giuseppe Moruzzi, 1, Pisa, Italy
- Scuola Superiore Sant'Anna, Institute of Life Sciences, Via Santa Cecilia, n., Pisa, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan, Italy
| | - Ehud Schwammenthal
- Tel Aviv University and Heart Center Sheba Medical Center, Emek Doran St, Ramat Gan, Israel
| | - Udo Sechtem
- Department of Cardiology, Robert Bosch Krakenhaus, Auerbachstraße 110, Stuttgart, Germany
| | - Mark Westwood
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila” - Euroecolab, Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Sos. Fundeni 258, Sector 2, Bucharest, Romania
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81
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Michels G, Pfister R, Hempel D. [Focused echocardiography in acute medicine]. Med Klin Intensivmed Notfmed 2018; 113:625-630. [PMID: 30302525 DOI: 10.1007/s00063-018-0493-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/12/2018] [Indexed: 12/17/2022]
Abstract
Focused echocardiography has become increasingly important for bedside diagnostics in acute medicine. Focused echocardiography can detect various cardiac pathologies, such as pericardial effusion, left ventricular dysfunction, right heart strain, relevant heart valve defects and dissection of the ascending aorta. Echocardiographic findings should be interpreted in the clinical context.
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Affiliation(s)
- G Michels
- Klinik III für Innere Medizin, Herzzentrum der Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum der Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - D Hempel
- Zentrale Notaufnahme, Medizinische Fakultät, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Magdeburg, Deutschland
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Via G, Tavazzi G. Diagnosis of diastolic dysfunction in the emergency department: really at reach for minimally trained sonologists? A call for a wise approach to heart failure with preserved ejection fraction diagnosis in the ER. Crit Ultrasound J 2018; 10:26. [PMID: 30294760 PMCID: PMC6174119 DOI: 10.1186/s13089-018-0107-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 09/08/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- Gabriele Via
- Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland.
| | - Guido Tavazzi
- Emergency Department, Anaesthesia and Intensive Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, Anaesthesia, Intensive Care and Pain Therapy Unit, University of Pavia, Pavia, Italy
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83
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Sampaio F, Ribeiras R, Galrinho A, Teixeira R, João I, Trabulo M, Quelhas I, Cabral S, Ribeiro J, Mendes M, Morais J. Documento de Consenso e Recomendações para a realização de Ecocardiografia Transtorácica em Portugal. Rev Port Cardiol 2018; 37:637-644. [DOI: 10.1016/j.repc.2018.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 04/16/2018] [Accepted: 05/14/2018] [Indexed: 11/25/2022] Open
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84
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Consensus document on transthoracic echocardiography in Portugal. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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