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Varghese MS, Strom JB, Kannam JP, Fostello SE, Riley MF, Manning WJ. Impact of the COVID-19 pandemic on cardiology fellow echocardiography education at a large academic center. BMC MEDICAL EDUCATION 2022; 22:863. [PMID: 36514029 PMCID: PMC9747257 DOI: 10.1186/s12909-022-03880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 11/09/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND In response to COVID-19 pandemic state restrictions, our institution deferred elective procedures from 3/15/2020 to 6/13/2020, and removed cardiology fellows from the echocardiography rotation to staff clinical services. We assessed the impact of the COVID-19 pandemic on fellow education and echocardiography volumes. METHODS Our institutional database was used to examine volumes of transthoracic (TTE), stress (SE), and transesophageal echocardiograms (TEE) from 7/1/2018 to 10/10/2020. Study volumes were compared in three intervals: pre-pandemic (7/1/2018- 3/14/2020), pandemic (3/15/2020-6/13/2020), and pandemic recovery (6/14/2020-10/10/2020). We examined weekly number of TTEs performed or interpreted by cardiology fellows during the study period, and compared these to the two previous academic years. RESULTS Weekly TTE volume declined by 54% during the pandemic, and increased by 99% during pandemic recovery, (p < 0.05). SE and TEE revealed similar trends. A strong correlation between weekly TTE volume and inpatient admissions was observed during the study period (rs=0.67, p < 0.05). Weekly fellow TTE scans declined by 78% during the pandemic, with a 380% increase during pandemic recovery (p < 0.05). Weekly fellow TTE interpretations declined by 56% during the pandemic, with a 76% increase during pandemic recovery (p < 0.05). CONCLUSION COVID restrictions between 3/15/2020- 6/14/2020 coincided with a marked decline in TTE, SE, and TEE volumes, with an increase similar to near pre-pandemic volumes during the pandemic recovery period. A similar decline with the onset of COVID restrictions, and increase to pre-restriction volumes thereafter was observed with fellow scans and interpretations, but total academic year fellow training volumes remained depressed. With the ongoing COVID-19 pandemic and rise of multiple variants, training programs may need to adjust fellows' clinical responsibilities so as to support achievement of echocardiography training certification.
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Affiliation(s)
- Merilyn S. Varghese
- Department of Medicine (Cardiovascular Diseases), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, 02215 Boston, MA USA
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, MA USA
| | - Jordan B. Strom
- Department of Medicine (Cardiovascular Diseases), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, 02215 Boston, MA USA
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, MA USA
| | - Joseph P. Kannam
- Department of Medicine (Cardiovascular Diseases), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, 02215 Boston, MA USA
| | - Sarah E. Fostello
- Non-Invasive Cardiology Department, Beth Israel Lahey Health- Plymouth Hospital, Plymouth, MA USA
| | - Marilyn F. Riley
- Department of Medicine (Cardiovascular Diseases), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, 02215 Boston, MA USA
| | - Warren J. Manning
- Department of Medicine (Cardiovascular Diseases), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, 02215 Boston, MA USA
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
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Douflé G, Urner M, Dragoi L, Jain A, Brydges R, Piquette D. Evaluation of an advanced critical care echocardiography program: a mixed methods study. Can J Anaesth 2022; 69:1260-1271. [PMID: 35819631 DOI: 10.1007/s12630-022-02281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 03/04/2022] [Accepted: 04/11/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Limited data exist on advanced critical care echocardiography (CCE) training programs for intensivists. We sought to describe a longitudinal echocardiography program and investigate the effect of distributed conditional supervision vs predefined en-bloc supervision, as well as the effect of an optional echocardiography laboratory rotation, on learners' engagement. METHODS In this mixed methods study, we enrolled critical care fellows and faculty from five University of Toronto-affiliated intensive care units (ICU) between July 2015 and July 2018 in an advanced training program, comprising theoretical lectures and practical sessions. After the first year, the program was modified with changes to supervision model and inclusion of a rotation in the echo laboratory. We conducted semistructured interviews and investigated the effects of curricular changes on progress toward portfolio completion (150 transthoracic echocardiograms) using a Bayesian framework. RESULTS Sixty-five learners were enrolled and 18 were interviewed. Four (9%) learners completed the portfolio. Learners reported lack of time and supervision, and skill complexity as the main barriers to practicing independently. Conditional supervision was associated with a higher rate of submitting unsupervised echocardiograms than unconditional supervision (rate ratio, 1.11, 95% credible interval, 1.08 to 1.14). After rotation in the echocardiography laboratory, submission of unsupervised echocardiograms decreased. CONCLUSION Trainees perceived lack of time and limited access to supervision as major barriers to course completion. Nevertheless, successful portfolio completion was related to factors other than protected time in the echocardiography laboratory or unconditional direct supervision in ICU. Further research is needed to better understand the factors promoting success of CCE training programs.
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Affiliation(s)
- Ghislaine Douflé
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Martin Urner
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Laura Dragoi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Aditi Jain
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Ryan Brydges
- The Wilson Centre for Research in Healthcare Education, University of Toronto, Toronto, ON, Canada
| | - Dominique Piquette
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre for Research in Healthcare Education, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Shi F, Zhang Y, Sun LX, Long S. Life-threatening subclavian artery bleeding following percutaneous coronary intervention with stent implantation: A case report and review of literature. World J Clin Cases 2022; 10:1937-1945. [PMID: 35317135 PMCID: PMC8891778 DOI: 10.12998/wjcc.v10.i6.1937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/26/2021] [Accepted: 01/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vascular complications of transradial percutaneous coronary intervention (PCI) are rare and usually occur at the access site below the elbow. Life-threatening vascular complications during transradial PCI therapy, such as vessel perforation and dissection in the brachiocephalic, subclavian, internal mammary, and thyrocervical arteries, are rarely reported. Subclavian artery bleeding is a potentially serious complication of vascular interventional procedures leading to tracheal obstruction, hemothorax, respiratory failure, hemorrhagic shock, and death if not diagnosed early and treated promptly.
CASE SUMMARY A male patient with typical angina pectoris underwent coronary angiography and stent implantation. During the procedure, the patient felt pharyngeal pain and tightness, which we mistook for myocardial ischemia. After PCI, swelling in the right neck and supraclavicular area was observed. The patient experienced dyspnea, emergency endotracheal intubation was performed, and then a sudden drop in blood pressure was observed. Ultrasound and contrast-enhanced computed tomography scans demonstrated a cervical hematoma severely compressing the trachea due to subclavian artery bleeding. Brachiocephalic angiography revealed a vascular injury site at the root of the right subclavian artery at the intersection of the right common carotid artery. A covered stent was deployed to the right subclavian artery with successful sealing of the perforation, and a bare stent was implanted in the junction of the right common carotid and brachiocephalic arteries to prevent obstruction of blood flow to the brain.
CONCLUSION Subclavian artery bleeding is a lifethreatening complication of PCI. Early prevention, rapid recognition, and prompt treatment may improve the prognosis.
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Affiliation(s)
- Fei Shi
- Department of Cardiology, The Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
| | - Ying Zhang
- Department of Cardiology, The Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
| | - Li-Xian Sun
- Department of Cardiology, The Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
| | - Sen Long
- Traditional Chinese Medicine, The Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
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Sun HY. Prenatal diagnosis of congenital heart defects: echocardiography. Transl Pediatr 2021; 10:2210-2224. [PMID: 34584892 PMCID: PMC8429868 DOI: 10.21037/tp-20-164] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/07/2020] [Indexed: 12/22/2022] Open
Abstract
Congenital heart defects (CHD) are the most common congenital anomaly, and the majority can be diagnosed during prenatal life. Prenatal detection rates remain highly variable, as most CHD occur in low risk pregnancies and therefore depend on the maternal obstetric provider to recognize fetal cardiac abnormality on obstetric screening anatomic ultrasound. Fetuses with abnormal findings on obstetric screening anatomic ultrasound and/or risk factors for cardiac disease should be referred for evaluation with fetal echocardiography. Fetal echocardiography should be performed by specialized sonographers and interpreted by physicians with knowledge of evolving fetal cardiac anatomy and physiology throughout gestation. A fetal echocardiography examination, which can be done from the late first trimester onward, utilizes a standardized and systemic approach to diagnose fetuses with CHD or other forms of primary or secondary cardiac disease. The field of fetal cardiology has advanced past the accurate prenatal diagnosis of simple and complex CHD, as fetal echocardiography enables understanding of dynamic fetal cardiac physiology and consideration of potential fetal/neonatal treatment. The greatest impact of fetal echocardiography remains identification of critical CHD before birth to allow immediate cardiac management after delivery to decrease neonatal morbidity and mortality. Analyzing the severity of abnormal cardiac physiology in various forms of CHD before birth allows the fetal cardiologist to prognosticate effects on the developing fetus, predict risk of postnatal hemodynamic instability, guide delivery planning through multidisciplinary collaboration, and anticipate how the disease will impact the neonate after delivery.
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Affiliation(s)
- Heather Y Sun
- Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, San Diego, CA, USA
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Comparative Early Hemodynamic Profiles in Patients Presenting to the Emergency Department with Septic and Nonseptic Acute Circulatory Failure Using Focused Echocardiography. Shock 2021; 53:695-700. [PMID: 31568225 PMCID: PMC7237072 DOI: 10.1097/shk.0000000000001449] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Objective: We evaluated the early hemodynamic profile of patients presenting with acute circulatory failure to the Emergency Department (ED) using focused echocardiography performed by emergency physicians after a dedicated training program. Methods: Patients presenting to the ED with an acute circulatory failure of any origin were successively examined by a recently trained emergency physician and by an expert in critical care echocardiography. Operators independently performed and interpreted online echocardiographic examinations to determine the leading mechanism of acute circulatory failure. Results: Focused echocardiography could be performed in 100 of 114 screened patients (55 with sepsis/septic shock and 45 with shock of other origin) after a median fluid loading of 500 mL (interquartile range: 187–1,500 mL). A hypovolemic profile was predominantly observed whether the acute circulatory failure was of septic origin or not (33/55 [60%] vs. 23/45 [51%]: P = 0.37). Although a vasoplegic profile associated with a hyperkinetic left ventricle was most frequently identified in septic patients when compared with their counterparts (17/55 [31%] vs. 5/45 [11%]: P = 0.02), early left or right ventricular failure was observed in 31% of them. Hemodynamic profiles were adequately appraised by recently trained emergency physicians, as reflected by a good-to-excellent agreement with the expert's assessment (Κ: 0.61–0.85). Conclusions: Hypovolemia was predominantly identified in patients presenting to the ED with acute circulatory failure. Although vasoplegia was more frequently associated with sepsis, early ventricular dysfunction was also depicted in septic patients. Focused echocardiography seemed reliable when performed by recently trained emergency physicians without previous experience in ultrasound.
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Online Learning and Echocardiography Boot Camp: Innovative Learning Platforms Promoting Blended Learning and Competency in Pediatric Echocardiography. Pediatr Cardiol 2021; 42:389-396. [PMID: 33179179 DOI: 10.1007/s00246-020-02494-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022]
Abstract
Mastering pediatric echocardiography (PE) requires a substantial knowledge base of echo theory and congenital heart disease (CHD), along with technical proficiency. Online self-directed learning has become increasingly utilized among medical trainees to promote competency within medical subspecialties. We sought to evaluate the impact of online learning combined with lecture-based and hands-on teaching on the acquisition of PE knowledge and confidence in pediatric cardiology and pediatric critical care fellows. We prospectively enrolled 124 learners from 2016 to 2019. These included 40 incoming cardiology and critical care fellows at Texas Children's Hospital (TCH) as well as 84 national and international participants recruited from our online echo education website. All participants completed online learning modules through our website ( www.pedecho.org ), which covers pediatric echo physics, Doppler, technique, normal anatomy, atrial septal defects, and ventricular septal defects. TCH cardiology and critical care fellows subsequently participated in an Echo Boot Camp (BC), a 3-day training program with hands-on workshops and didactic lectures. Knowledge was assessed using an 80-question pre and post-test multiple choice exams. The online learning group demonstrated improvement in exam scores following online learning (PRE 49.1 ± 15.3 vs. POST 67.8 ± 17%; p ≤ 0.01). Echo Boot Camp fellows were noted to have further incremental improvement in test scores following BC (PRE 48% ± 13% vs. POST MODULE 68.6% ± 15% vs. POST BC 75.7% ± 13%; p ≤ 0.01). Self-assessment regarding confidence in context areas showed a substantial gain in self perceived interpretive confidence across all groups as well as procedural confidence in BC participants. Online learning significantly promotes the acquisition of echocardiography knowledge. Additional lecture-based and hands-on teaching in the form of an Echo Boot Camp can further enhance knowledge and interpretative skills. Both of these learning platforms appear to work in concert as powerful and effective tools in fellow education.
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Russell FM, Ferre R, Ehrman RR, Noble V, Gargani L, Collins SP, Levy PD, Fabre KL, Eckert GJ, Pang PS. What are the minimum requirements to establish proficiency in lung ultrasound training for quantifying B-lines? ESC Heart Fail 2020; 7:2941-2947. [PMID: 32697034 PMCID: PMC7524048 DOI: 10.1002/ehf2.12907] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 12/21/2022] Open
Abstract
AIMS The goal of this study was to determine the number of scans needed for novice learners to attain proficiency in B-line quantification compared with expert interpretation. METHODS AND RESULTS This was a prospective, multicentre observational study of novice learners, physicians and non-physicians from three academic institutions. Learners received a 2 h lung ultrasound (LUS) training session on B-line assessment, including lecture, video review to practice counting and hands-on patient scanning. Learners quantified B-lines using an eight-zone scanning protocol in patients with suspected acute heart failure. Ultrasound (US) machine settings were standardized to a depth of 18 cm and clip length of 6 s, and tissue harmonics and multibeam former were deactivated. For quantification, the intercostal space with the greatest number of B-lines within each zone was used for scoring. Each zone was given a score of 0-20 based on the maximum number of B-lines counted during one respiratory cycle. The B-line score was determined by multiplying the percentage of the intercostal space filled with B-lines by 20. We compared learner B-line counts with a blinded expert reviewer (five US fellowship-trained faculty with > 5 years of clinical experience) for each lung zone scanned; proficiency was defined as an intraclass correlation of > 0.7. Learning curves for each learner were constructed using cumulative sum method for statistical analysis. The Wilcoxon rank-sum test was used to compare the number of scans required to reach proficiency between different learner types. Twenty-nine learners (21 research associates, 5 residents and 3 non-US-trained emergency medicine faculty) scanned 2629 lung zones with acute pulmonary oedema. After a mean of 10.8 (standard deviation 14.0) LUS zones scanned, learners reached the predefined proficiency standard. The number of scanned zones required to reach proficiency was not significantly different between physicians and non-physicians (P = 0.26), learners with no prior US experience vs. > 25 prior patient scans (P = 0.64) and no prior vs. some prior LUS experience (P = 0.59). The overall intraclass correlation for agreement between learners and experts was 0.74 and 0.80 between experts. CONCLUSIONS Our results show that after a short, structured training, novice learners are able to achieve proficiency for quantifying B-lines on LUS after scanning 11 zones. These findings support the use of LUS for B-line quantification by non-physicians in clinical and research applications.
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Affiliation(s)
- Frances M Russell
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robinson Ferre
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robert R Ehrman
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Vicki Noble
- Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Phillip D Levy
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - George J Eckert
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Dieden A, Carlson E, Gudmundsson P. Learning echocardiography- what are the challenges and what may favour learning? A qualitative study. BMC MEDICAL EDUCATION 2019; 19:212. [PMID: 31196099 PMCID: PMC6567468 DOI: 10.1186/s12909-019-1656-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/06/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Echocardiography is a frequently used imaging modality requiring extensive training to master. In order to develop curriculums and teaching material fully favouring students learning within echocardiography, this study aims to investigate students' experiences of learning echocardiography, focusing on that which is perceived as the main challenges as well as what might aid learning within the area. The findings could serve as a foundation in the development of new teaching material or curriculums. METHODS A qualitative study was performed with data gathered through two audio-recorded focus group interviews with four third year students from the biomedical laboratory programme at Malmö University in each group. Data was analysed by manifest content analysis. RESULTS Findings were clustered into two categories reflecting the main findings in the text - practical skills and bridging the theory-practice-gap. Students expressed that main challenges when initially learning echocardiography were the projections and handling the probe as well as connecting ultrasound physics and measurements to practical application. Things that aided their learning were immediate feedback, "playing" with the ultrasound machine, video lectures, the possibility to swiftly alternate between practice and theory as well as the learning by their mistakes in a risk-free environment. CONCLUSIONS This study shows the main challenges when initially learning echocardiography and what might be helpful during the learning process. These findings may be useful when developing curriculums or new teaching material within echocardiography. One suggestion might be to develop digital resources such as virtual laboratories (vLABs).
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Affiliation(s)
- Anna Dieden
- Department of Biomedical Science, Malmö University, Malmö, Sweden
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Puchalski MD, Lui GK, Miller-Hance WC, Brook MM, Young LT, Bhat A, Roberson DA, Mercer-Rosa L, Miller OI, Parra DA, Burch T, Carron HD, Wong PC. Guidelines for Performing a Comprehensive Transesophageal Echocardiographic. J Am Soc Echocardiogr 2019; 32:173-215. [DOI: 10.1016/j.echo.2018.08.016] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Wang J, Ye Y, Xin T, Zhang X, Chen S, Wu Y, Sun K. Is echocardiography necessary for all single umbilical artery fetuses? A retrospective study in a selected Chinese population. J Obstet Gynaecol Res 2019; 45:803-809. [PMID: 30644151 DOI: 10.1111/jog.13912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 12/08/2018] [Indexed: 12/26/2022]
Abstract
AIM Previous evidence on the relationship between single umbilical artery (SUA) and congenital heart disease (CHD) is controversial. We thus conducted a retrospective study to explore the potential risk factors associated with CHD in SUA fetuses, and verify if all these SUA fetuses should be referred for detail fetal echocardiography. METHODS We reviewed medical records of SUA fetuses referred to Xinhua Hospital for fetal echocardiography between September 2009 and February 2014. All the pregnancies were divided into two groups of CHD and non-CHD according to the results of fetal echocardiography. The maternal and fetal characteristics were compared via χ2 test and Fishers' test. Furthermore, Poisson regression was used to analyze the risk factors associated with CHD in SUA pregnancies. RESULTS Nineteen CHD cases (12.5%) were detected among 152 SUA fetuses, all with abnormal cardiac views during obstetric screening ultrasound (P < 0.001). χ2 test showed that abnormal cardiac screening findings, extracardiac abnormality and infection or threatened abortion during first trimester were significantly associated with prenatal detection of CHD (P < 0.001). Multivariable Poisson regression after adjustment found that SUA fetuses with extracardiac abnormality had 4.74 (95% confidence interval: 1.89, 11.90) times higher risk of CHD. CONCLUSION Incidence of CHD was higher in SUA cases, and CHD fetuses could be screened efficiently by abnormal cardiac screening during obstetric screening ultrasound. SUA fetuses with extracardiac abnormality and maternal risk factors have higher risk of CHD, and should be strongly recommended for fetal echocardiography. In contrast, SUA fetuses without above situations might only need routine obstetric follow-up.
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Affiliation(s)
- Jian Wang
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujiao Ye
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tiantian Xin
- Department of Pediatric, Zhang Jiagang First People Hospital, Suchou University, Jiangsu, China
| | - Xi Zhang
- Clinical Research Unit, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sun Chen
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yurong Wu
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Sun
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Kheiri B, Osman M, Abdalla A, Haykal T, Ahmed S, Bachuwa G, Hassan M, Bhatt DL. Catheter ablation of atrial fibrillation with heart failure: An updated meta-analysis of randomized trials. Int J Cardiol 2018; 269:170-173. [DOI: 10.1016/j.ijcard.2018.07.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/05/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
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Chen R, Zhu M, Sahn DJ, Ashraf M. Non-Invasive Evaluation of Heart Function with Four-Dimensional Echocardiography. PLoS One 2016; 11:e0154996. [PMID: 27144844 PMCID: PMC4856388 DOI: 10.1371/journal.pone.0154996] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 04/23/2016] [Indexed: 12/15/2022] Open
Abstract
Background The aim of this study is to assess the accuracy and feasibility of left ventricular systolic function determined by four-dimensional echocardiography (4DE). Methods Latex balloons were sewn into the left ventricle (LV) of 20 freshly harvested pig hearts which were then passively driven by a pulsatile pump apparatus. Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS) and left ventricular ejection fraction (LVEF) derived from 4DEand two-dimensional echocardiography (2DE)-derived LVEF were quantified at different stroke volumes (SV) 30–70 ml and correlated with sonomicrometry data. Results In all comparisons, GLS, GCS, GAS, 2DE-LVEF, and 4DE-LVEF demonstrated strong correlations with sonomicrometry data (r = 0.77, r = 0.89, r = 0.79, r = 0.93, r = 0.96, all P <0.001). Bland-Altman analyses showed slight overestimations of echo-derived GLS, GCS, 2DE-LVEF and 3DE-LVEF over sonomicrometry values (bias = 2.88, bias = 3.99, bias = 3.37, bias = 2.78, respectively). Furthermore, there is better agreement between GCS, 4D LVEF and sonomicrometry values compared with GLS and 2D LVEF. Conclusion Four-dimensional echocardiography accurately assesses LV function. GCS derived by 4DE is a potential alternative parameter to quantify LV systolic function.
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Affiliation(s)
- Ran Chen
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, China
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, United States of America
| | - Meihua Zhu
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, United States of America
| | - David J. Sahn
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, United States of America
| | - Muhammad Ashraf
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, United States of America
- * E-mail:
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Levine JC, Geva T, Brown DW. Competency Testing for Pediatric Cardiology Fellows Learning Transthoracic Echocardiography: Implementation, Fellow Experience, and Lessons Learned. Pediatr Cardiol 2015; 36:1700-11. [PMID: 26123811 DOI: 10.1007/s00246-015-1220-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/12/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED There is currently great interest in measuring trainee competency at all levels of medical education. In 2007, we implemented a system for assessing cardiology fellows' progress in attaining imaging skills. This paradigm could be adapted for use by other cardiology programs. METHODS Evaluation consisted of a two-part exercise performed after years 1 and 2 of pediatric cardiology training. Part 1: a directly observed evaluation of technical skills as fellows imaged a normal subject (year 1) and a patient with complex heart disease (year 2). Part 2: fellows interpreted and wrote reports for two echocardiograms illustrating congenital heart disease. These were graded for accuracy and facility with communicating pertinent data. After 5 years of testing, fellows were surveyed about their experience. In 5 years, 40 fellows were tested at least once. Testing identified four fellows who underperformed on the technical portion and four on the interpretive portion. Surveys were completed by 33 fellows (83 %). Most (67 %) felt that intermittent observation by faculty was inadequate for assessing skills and that procedural volume was a poor surrogate for competency (58 %). Posttest feedback was constructive and valuable for 90, and 70 % felt the process helped them set goals for skill improvement. Overall, fellows felt this testing was fair and should continue. Fellow performance and responses identified programmatic issues that were creating barriers to learning. We describe a practical test to assess competency for cardiology fellows learning echocardiography. This paradigm is feasible, has excellent acceptance among trainees, and identifies trainees who need support. Materials developed could be easily adapted to help track upcoming ACGME-mandated metrics.
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Affiliation(s)
- Jami C Levine
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. .,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - David W Brown
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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15
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Müller S, Velik-Salchner C, Edlinger M, Bonaros N, Heinz A, Feuchtner G, Bartel T. Intracardiac Doppler Echocardiography for Monitoring of Pulmonary Artery Pressures in High-Risk Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Soc Echocardiogr 2015; 29:83-91. [PMID: 26494418 DOI: 10.1016/j.echo.2015.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Uncontrolled pulmonary hypertension may cause worse outcomes after transcatheter aortic valve replacement (TAVR), while hemodynamic monitoring is desirable for risk control. Pulmonary artery pressure (PAP) readings obtained by intracardiac Doppler echocardiography were evaluated. METHODS In 114 patients with symptomatic aortic stenosis and median Society of Thoracic Surgeons scores of 10.5% (interquartile range, 7.7%-15.0%), transfemoral and transapical TAVR was guided by intracardiac Doppler echocardiography. The continuous-wave Doppler beam interrogated the jet of tricuspid regurgitation from the "home view" position. Systolic PAP (PAPs) was estimated as the sum of the pressure gradient derived from the maximum transtricuspid regurgitation jet velocity and the central venous pressure. Mean PAP (PAPm) was calculated by the mean gradient method (1) and the Chemla formula (2). Measurements were obtained immediately before and after TAVR. RESULTS Pre- and postinterventional readings showed marginal pressure underestimation in comparison with measurements derived from right-heart catheterization: PAPs, -2.7 (95% CI, -3.3 to 2.1) and -1.4 (95% CI, -1.9 to -0.9); PAPm by the mean gradient method, -1.9 (95% CI, -2.2 to -1.6) and -0.1 (95% CI, -0.4 to 0.2). Agreement (95% limits) for PAPs was -8.6 to 3.2 and -6.8 to 4.0; agreement for PAPm by the mean gradient method was -5.4 to 1.6 and -3.4 to 3.2. The repeatability coefficient (95% limits of agreement) for PAPs was excellent: 3.4 (-4.2 to 2.5) and 5.5 (-5.3 to 5.8); repeatability for PAPm was higher by the mean gradient method than by the Chemla method. In ≥ 85% of patients with pulmonary hypertension, PAPm improved after valve deployment. CONCLUSIONS Intracardiac Doppler echocardiography-derived monitoring of PAP by the mean gradient method is accurate and well applicable to high-risk TAVR candidates for intraprocedural risk control.
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Affiliation(s)
- Silvana Müller
- Division of Cardiology, Department of Internal Medicine III, Innsbruck University Medical School, Innsbruck, Austria
| | | | - Michael Edlinger
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck University Medical School, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck University Medical School, Innsbruck, Austria
| | - Anneliese Heinz
- Department of Cardiac Surgery, Innsbruck University Medical School, Innsbruck, Austria
| | - Gudrun Feuchtner
- Department of Radiology II, Innsbruck University Medical School, Innsbruck, Austria
| | - Thomas Bartel
- Department of Cardiology, Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
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16
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Abstract
Focused cardiac ultrasound (FCU) is a bedside examination of the heart performed with a small, portable ultrasound platform by a physician as an adjunct to their physical examination. The goal is to recognize a narrow list of abnormalities that are both detectable by physicians with limited ultrasound training and have high clinical assessment value. Results from the FCU examination are integrated with traditional bedside assessment (physical examination and history) to provide early management plans and patient triage in settings when echocardiography cannot be obtained or is not immediately available.
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Affiliation(s)
- Kirk T Spencer
- University of Chicago, 5841 S Maryland MC 5084, Chicago, IL, 60637, USA,
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17
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Siqueira VN, Mancuso FJN, Campos O, De Paola AA, Carvalho AC, Moises VA. Training Program for Cardiology Residents to Perform Focused Cardiac Ultrasound Examination with Portable Device. Echocardiography 2015; 32:1455-62. [DOI: 10.1111/echo.12887] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Vicente N. Siqueira
- Cardiology Department; Paulista School of Medicine; Federal University of São Paulo; Brazil
| | | | - Orlando Campos
- Cardiology Department; Paulista School of Medicine; Federal University of São Paulo; Brazil
| | - Angelo A. De Paola
- Cardiology Department; Paulista School of Medicine; Federal University of São Paulo; Brazil
| | - Antonio C. Carvalho
- Cardiology Department; Paulista School of Medicine; Federal University of São Paulo; Brazil
| | - Valdir A. Moises
- Cardiology Department; Paulista School of Medicine; Federal University of São Paulo; Brazil
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18
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Walley PE, Walley KR, Goodgame B, Punjabi V, Sirounis D. A practical approach to goal-directed echocardiography in the critical care setting. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:681. [PMID: 25672460 PMCID: PMC4331439 DOI: 10.1186/s13054-014-0681-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Urgent cardiac ultrasound examination in the critical care setting is clinically useful. Application of goal-directed echocardiography in this setting is quite distinct from typical exploratory diagnostic comprehensive echocardiography, because the urgent critical care setting mandates a goal-directed approach. Goal-directed echocardiography most frequently aims to rapidly identify and differentiate the cause(s) of hemodynamic instability and/or the cause(s) of acute respiratory failure. Accordingly, this paper highlights 1) indications, 2) an easily memorized differential diagnostic framework for goal-directed echocardiography, 3) clinical questions that must be asked and answered, 4) practical issues to allow optimal image capture, 5) primary echocardiographic views, 6) key issues addressed in each view, and 7) interpretation of findings within the differential diagnostic framework. The most frequent indications for goal-directed echocardiography include 1) the spectrum of hemodynamic instability, shock, and pulseless electrical activity arrest and 2) acute respiratory failure. The differential diagnostic categories for hemodynamic instability can be remembered using the mnemonic ‘SHOCK’ (for Septic, Hypovolemic, Obstructive, Cardiogenic, and (K) combinations/other kinds of shock). RESP-F (for exacerbation of chronic Respiratory disease, pulmonary Embolism, ST changes associated with cardiac or pericardial disease, Pneumonia, and heart Failure) can be used for acute respiratory failure. The goals of goal-directed echocardiography in the unstable patient are: assessing global ventricular systolic function, identifying marked right ventricular and left ventricular enlargement, assessing intravascular volume, and the presence of a pericardial effusion. In an urgent or emergent setting, it is recommended to go directly to the best view, which is frequently the subcostal or apical view. The five views are the subcostal four-chamber view, subcostal inferior vena cava view, parasternal long axis view, parasternal short axis view, and the apical four chamber view. Always interpret goal-directed echocardiographic findings in the context of clinically available hemodynamic information. When goal-directed echocardiography is insufficient or when additional abnormalities are appreciated, order a comprehensive echocardiogram. Goal-directed echocardiography and comprehensive echocardiography are not to be used in conflict with each other.
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19
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Geisen M, Spray D, Nicholas Fletcher S. Echocardiography-Based Hemodynamic Management in the Cardiac Surgical Intensive Care Unit. J Cardiothorac Vasc Anesth 2014; 28:733-44. [DOI: 10.1053/j.jvca.2013.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Indexed: 11/11/2022]
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20
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Jozwiak M, Monnet X, Cinotti R, Bontemps F, Reignier J, Belliard G. Prospective assessment of a score for assessing basic critical-care transthoracic echocardiography skills in ventilated critically ill patients. Ann Intensive Care 2014; 4:12. [PMID: 25097797 PMCID: PMC4113285 DOI: 10.1186/2110-5820-4-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 04/07/2014] [Indexed: 11/20/2022] Open
Abstract
Background We studied a score for assessing basic transthoracic echocardiography (TTE) skills exhibited by residents who examined critically ill patients receiving mechanical ventilation. Methods We conducted a prospective study in the 16 residents who worked in our medical-surgical ICU between 1 May 2008 and 1 November 2009. The residents received theoretical teaching (two hours) then performed supervised TTEs during their six-month rotation. Their basic TTE skills in mechanically ventilated patients were evaluated after one (M1), three (M3), and six (M6) months by two experts, who used a scoring system devised for the study. After scoring, residents gave their hemodynamic diagnosis and suggested a treatment. Results The 4 residents with previous TTE skills obtained a significantly higher total score than did the 12 novices at M1 (18 (16 to 19) versus 13 (10 to 15), respectively, P = 0.03). In the novices, the total score increased significantly during training (M1, 13 (10 to 14); M3, 15 (12 to 16); and M6, 17 (15 to 18); P < 0.001) and correlated significantly with the number of supervised TTEs (r = 0.68, P < 0.0001). In the overall population, agreement with experts regarding the diagnosis and treatment was associated with a significantly higher total score (17 (16 to 18) versus 13 (12 to 16), P = 0.002). A total score ≥ 19/20 points had 100% specificity (95% confidence interval, 79 to 100%) for full agreement with the experts regarding the diagnosis and treatment. Conclusions Our results validate the scoring system developed for our study of the assessment of basic critical-care TTE skills in residents.
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Affiliation(s)
- Mathieu Jozwiak
- Centre Hospitalier Départemental de la Vendée, service de réanimation, La Roche-sur-Yon F-85000, France
| | - Xavier Monnet
- AP-HP, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale, Le Kremlin-Bicêtre F-94270, France ; Faculté de Médecine Paris-Sud, Université Paris-Sud, EA4533, Le Kremlin-Bicêtre F-94270, France
| | - Raphaël Cinotti
- Centre Hospitalo-Universitaire Guillaume et René Laennec, service de réanimation chirurgicale, Nantes F-44000, France
| | - Fréderic Bontemps
- Centre Hospitalier Côte de Lumière, service de médecine polyvalente, Les Sables d'Olonne F-85100, France
| | - Jean Reignier
- Centre Hospitalier Départemental de la Vendée, service de réanimation, La Roche-sur-Yon F-85000, France
| | - Guillaume Belliard
- Centre Hospitalier Bretagne Sud Lorient, service de réanimation médicale, Lorient F-56100, France
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21
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International consensus statement on training standards for advanced critical care echocardiography. Intensive Care Med 2014; 40:654-66. [PMID: 24615559 DOI: 10.1007/s00134-014-3228-5] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 01/21/2014] [Indexed: 12/14/2022]
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22
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Use of Three-Dimensional Speckle-Tracking Echocardiography for Quantitative Assessment of Global Left Ventricular Function: A Comparative Study to Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2014; 27:285-91. [DOI: 10.1016/j.echo.2013.11.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Indexed: 11/18/2022]
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23
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Guidelines for Performing a Comprehensive Transesophageal Echocardiographic Examination. Anesth Analg 2014; 118:21-68. [DOI: 10.1213/ane.0000000000000016] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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24
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Faris JG, Hartley K, Fuller CM, Langston RB, Royse CF, Veltman MG. Audit of Cardiac Pathology Detection Using a Criteria-Based Perioperative Echocardiography Service. Anaesth Intensive Care 2012; 40:702-9. [DOI: 10.1177/0310057x1204000418] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Transthoracic echocardiography is often used to screen patients prior to non-cardiac surgery to detect conditions associated with perioperative haemodynamic compromise and to stratify risk. However, anaesthetists’ use of echocardiography is quite variable. A consortium led by the American College of Cardiology Foundation has developed appropriate use criteria for echocardiography. At Joondalup Hospital in Western Australia, we have used these criteria to order echocardiographic studies in patients attending our anaesthetic preadmission clinic. We undertook this audit to determine the incidence of significant echocardiographic findings using this approach. In a 22-month period, 606 transthoracic echocardiographic studies were performed. This represented 8.7% of clinic attendees and 1.7% of all surgical patients. In about two-thirds of the patients, the indication for echocardiography was identified on the basis of a telephone screening questionnaire. The most common indications were poor exercise tolerance (27.4%), ischaemic heart disease (20.9%) and cardiac murmurs (16.3%). Over 26% of patients studied had significant cardiac pathology (i.e. moderate or severe echocardiographic findings), most importantly moderate or severe aortic stenosis (8.6%), poor left ventricular function (7.1%), a regional wall motion abnormality (4.3%) or moderate or severe mitral regurgitation (4.1%). Using appropriate use criteria to guide ordering transthoracic echocardiography studies led to a high detection rate of clinically important cardiac pathology in our perioperative service.
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Affiliation(s)
- J. G. Faris
- Department of Anaesthesia, Joondalup Health Campus, Perth, Western Australia, Australia
- Departments of Anaesthesia, Joondalup and Sir Charles Gairdner Hospitals, Perth; Professor and Discipline Leader in Anaesthesia, School of Medicine Fremantle, University of Notre Dame Australia and Honorary Fellow, Faculty for Ultrasound Education, Department of Pharmacology, University of Melbourne
| | - K. Hartley
- Department of Anaesthesia, Joondalup Health Campus, Perth, Western Australia, Australia
| | - C. M. Fuller
- Department of Anaesthesia, Joondalup Health Campus, Perth, Western Australia, Australia
| | - R. B. Langston
- Department of Anaesthesia, Joondalup Health Campus, Perth, Western Australia, Australia
| | - C. F. Royse
- Department of Anaesthesia, Joondalup Health Campus, Perth, Western Australia, Australia
- Department of Pharmacology, University of Melbourne and Consultant Anaesthetist, Department of Anaesthesia and Pain Management, Royal Melbourne Hospital
| | - M. G. Veltman
- Department of Anaesthesia, Joondalup Health Campus, Perth, Western Australia, Australia
- Department of Anaesthesia, Joondalup Hospital, Perth; Professor, School of Medicine Fremantle, University of Notre Dame Australia and Honorary Fellow, Faculty for Ultrasound Education, Department of Pharmacology, University of Melbourne
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25
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Pelliccia F, Palmiero P, Maiello M, Losi MA. Italian Chapter of the International Society of Cardiovascular Ultrasound Expert Consensus Document on Training Requirements for Noncardiologists Using Hand-Carried Ultrasound Devices. Echocardiography 2012; 29:745-50. [DOI: 10.1111/j.1540-8175.2012.01720.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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26
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Reant P, Barbot L, Montaudon M, Landelle M, Arsac F, Dijos M, Pillois X, Touche C, Corneloup O, Roudaut R, Laurent F, Lafitte S. Robustness of a new three-dimensional echocardiographic algorithm for left ventricular volume and ejection fraction quantification: experts vs. novices. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:895-903. [DOI: 10.1093/ejechocard/jer179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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27
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Kleijn SA, Aly MFA, Terwee CB, van Rossum AC, Kamp O. Reliability of left ventricular volumes and function measurements using three-dimensional speckle tracking echocardiography. Eur Heart J Cardiovasc Imaging 2011; 13:159-68. [DOI: 10.1093/ejechocard/jer174] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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28
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29
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Macron L, Lairez O, Nahum J, Berry M, Deal L, Deux JF, Bensaid A, Dubois Rande JL, Gueret P, Lim P. Impact of acoustic window on accuracy of longitudinal global strain: a comparison study to cardiac magnetic resonance. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:394-9. [DOI: 10.1093/ejechocard/jer029] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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30
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Lipczyńska M, Szymański P, Klisiewicz A, Hoffman P. Hand-Carried Echocardiography in Heart Failure and Heart Failure Risk Population: A Community Based Prospective Study. J Am Soc Echocardiogr 2011; 24:125-31. [DOI: 10.1016/j.echo.2010.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Indexed: 11/28/2022]
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31
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Villa MP, Ianniello F, Tocci G, Evangelisti M, Miano S, Ferrucci A, Ciavarella GM, Volpe M. Early cardiac abnormalities and increased C-reactive protein levels in a cohort of children with sleep disordered breathing. Sleep Breath 2011; 16:101-10. [PMID: 21210231 DOI: 10.1007/s11325-010-0462-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 12/10/2010] [Accepted: 12/20/2010] [Indexed: 01/20/2023]
Abstract
BACKGROUND This study aims to evaluate left ventricular (LV) structure and function and inflammation in a paediatric population with sleep disordered breathing (SDB) and in control subjects. METHODS Forty-nine children with SDB and 21 healthy, age-matched subjects were enrolled. The diagnosis of obstructive sleep apnoea syndrome (OSAS) was confirmed by the laboratory polysomnography, showing an obstructive apnoea/hypopnoea index of more than one per hour, according to the criteria of the American Academy of Sleep Medicine and modified for paediatric population. Fasting blood samples for the biochemical evaluation (including high-sensitivity C-reactive protein (hsCRP) were drawn in the morning, after the polysomnographic examination in all patients with SDB and in the control group. All children underwent a two-dimensional colour Doppler cardiac examination with LV mass assessment and systolic and diastolic function evaluation. RESULTS Higher hsCRP levels were observed in subjects with OSAS than in children with primary snoring and in controls (0.8 ± 0.7 vs 0.3 ± 0.1 ng/dl, p = 0.001, and 0.4 ± 0.2 ng/dl, p = 0.01, respectively). The LV diastolic dysfunction was significantly more frequent in patients with severe OSAS and higher hsCRP levels than in control group. CONCLUSIONS This study shows that OSAS in children is associated with higher LV mass, early LV diastolic dysfunction and a pro-inflammatory state (high CRP levels). These findings might help to explain the higher incidence of cardiovascular morbidity in patients with OSAS.
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MESH Headings
- Adolescent
- Blood Pressure/physiology
- Body Mass Index
- C-Reactive Protein/metabolism
- Child
- Child, Preschool
- Comorbidity
- Diastole/physiology
- Echocardiography, Doppler, Color
- Female
- Humans
- Hypertrophy, Left Ventricular/blood
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/epidemiology
- Male
- Oxygen/blood
- Polysomnography
- Reference Values
- Sleep Apnea, Obstructive/blood
- Sleep Apnea, Obstructive/diagnosis
- Sleep Apnea, Obstructive/epidemiology
- Snoring/blood
- Snoring/diagnosis
- Snoring/epidemiology
- Ventricular Dysfunction, Left/blood
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/epidemiology
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Affiliation(s)
- Maria Pia Villa
- Division of Paediatrics, II Faculty of Medicine, La Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
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32
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Affiliation(s)
- Linda D. Gillam
- From the Division of Cardiology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY
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33
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Liel-Cohen N, Tsadok Y, Beeri R, Lysyansky P, Agmon Y, Feinberg MS, Fehske W, Gilon D, Hay I, Kuperstein R, Leitman M, Deutsch L, Rosenmann D, Sagie A, Shimoni S, Vaturi M, Friedman Z, Blondheim DS. A New Tool for Automatic Assessment of Segmental Wall Motion Based on Longitudinal 2D Strain. Circ Cardiovasc Imaging 2010; 3:47-53. [DOI: 10.1161/circimaging.108.841874] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Identification and quantification of segmental left ventricular wall motion abnormalities on echocardiograms is of paramount clinical importance but is still performed by a subjective visual method. We constructed an automatic tool for assessment of wall motion based on longitudinal strain.
Methods and Results—
Echocardiograms of 105 patients (3 apical views) were blindly analyzed by 12 experienced readers. Visual segmental scores (VSS) and peak systolic longitudinal strain were assigned to each of 18 segments per patient. Ranges of peak systolic longitudinal strain that best fit VSS (by receiver operating characteristic analysis) were used to generate automatic segmental scores (ASS). Comparisons of ASS and VSS were performed on 1952 analyzable segments. There was agreement of wall motion scores between both methods in 89.6% of normal, 39.5% of hypokinetic, and 69.4% of akinetic segments. Correlation between methods was
r
=0.63 (
P
<0.0001). Interobserver and intraobserver reliability using interclass correlation for scoring segmental wall motion into 3 scores by ASS was 0.82 and 0.83 and by VSS 0.70 and 0.69, respectively. Compared with VSS (majority rule), ASS had a sensitivity, specificity, and accuracy of 87%, 85%, and 86%, respectively. ASS and VSS had similar success rates for correct identification of wall motion abnormalities in territories supplied by culprit arteries. VSS had greater specificity and positive predictive values, whereas ASS had higher sensitivity and negative predictive values for identifying the culprit artery.
Conclusions—
Automatic quantification of wall motion on echocardiograms by this tool performs as well as visual analysis by experienced echocardiographers, with a greater reliability and similar agreement to angiographic findings.
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Affiliation(s)
- Noah Liel-Cohen
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Yossi Tsadok
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Ronen Beeri
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Peter Lysyansky
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Yoram Agmon
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Micha S. Feinberg
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Wolfgang Fehske
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Dan Gilon
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Ilan Hay
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Rafael Kuperstein
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Marina Leitman
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Lisa Deutsch
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - David Rosenmann
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Alik Sagie
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Sarah Shimoni
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Mordehay Vaturi
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Zvi Friedman
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - David S. Blondheim
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
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Thys DM. Cardiac Anesthesia: Thirty Years Later—The Second Annual Arthur E. Weyman Lecture. Anesth Analg 2009; 109:1782-90. [DOI: 10.1213/ane.0b013e3181be4002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ippisch HM, Kimball TR. The impact of evolving hand-carried echocardiographic technology on outpatient physical examination accuracy in pediatric cardiology. CONGENIT HEART DIS 2008; 2:170-8. [PMID: 18377461 DOI: 10.1111/j.1747-0803.2007.00052.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cardiac auscultory skills are declining. Hand-carried ultrasound (HCU) has been proposed as a method to enhance diagnostic accuracy of the physical examination (PE). However, features of HCU devices are varied. OBJECTIVE The aim of this study was to compare the diagnostic accuracies of an experienced pediatric cardiac PE alone vs. the PE combined with the assistance of an HCU device when using 2 HCU devices with different capabilities. The results were compared with conventional echo as the reference standard. METHODS All outpatients seen by a single pediatric cardiologist underwent physical examination and HCU. Two HCU devices were compared. The first HCU device (HCU-1) had limited options with only 2-dimensional echo, limited Doppler, and a single transducer frequency (2.5 MHz). The second HCU device (HCU-2) was a unit with greater transducer choices and a wider variety of applications. A single echocardiologist performed the PEs & HCUs. Conventional echoes were performed by a pediatric sonographer and interpreted by a second pediatric echocardiologist. Examination accuracies centered on 3 broad areas including: cardiac shunts, valvular insufficiency, and valvular anatomy. The accuracy of the PE alone was compared with the accuracy of the combined PE & HCU-1 vs. PE & HCU-2. RESULTS Thirty patients total (3 months-19 years, 4-82 kg) were evaluated. Eighteen were examined with HCU-1 and 12 were examined with HCU-2. The accuracy of the combined PE & HCU-1 did not improve accuracy over the PE alone. However, the accuracy of the combined PE & HCU-2 was greater than the PE alone. CONCLUSIONS Use of a limited HCU device does not improve diagnostic accuracy over an experienced PE alone and may actually worsen diagnostic accuracy in some cases. However, the improvements in newer HCU devices may enhance diagnostic accuracy over the PE alone, even for experienced physicians.
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Affiliation(s)
- Holly M Ippisch
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. Holly.Ippisch@ cchmc.org
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Symptom-to-door time in ST segment elevation myocardial infarction: overemphasized or overlooked? Results from the AMI-McGill study. Can J Cardiol 2008; 24:213-6. [PMID: 18340392 DOI: 10.1016/s0828-282x(08)70587-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ischemic time is a major determinant of infarct size in ST segment elevation myocardial infarction (STEMI). Emphasis is placed on reducing the door-to-reperfusion therapy time component, whereas the symptom-to-door time is often overlooked. OBJECTIVES To correlate the symptom-to-door time with left ventricular ejection fraction (LVEF) in patients with STEMI. METHODS Acute Myocardial Infarction (AMI)-McGill was a cohort study of consecutive patients with STEMI who presented to three adult university hospitals. Multivariate linear regression was performed to correlate the symptom-to-door time with postinfarction LVEF adjusted for reperfusion method, prior myocardial infarction and components of the Thrombolysis In Myocardial Infarction (TIMI) risk score. RESULTS There were 188 patients, with a mean age of 66 years. On arrival to hospital, 23% of patients were in Killip class II to IV and 87% received reperfusion therapy (20% fibrinolytic therapy and 67% primary percutaneous coronary intervention). The median symptom-to-door time was 120 min (first quartile: 60 min, third quartile: 290 min) and the median door-to-reperfusion therapy time was 93 min (first quartile: 54 min, third quartile: 155 min). Three variables were independently correlated with LVEF in the study's regression model: symptom-to-door time (beta: -0.66, 95% CI -1.18 to -0.14; P=0.01), Killip class II to IV on arrival (beta: -6.43, 95% CI -11.87 to -0.99; P=0.02) and anterior territory of the infarction (beta: -5.86, 95% CI -10.55 to -1.18; P=0.02). CONCLUSIONS Symptom-to-door time was negatively correlated with postinfarction LVEF in patients with STEMI. Strategies to shorten this delay, such as educating high-risk patients about the symptoms of AMI, should be considered.
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Leitão CB, Canani LH, Kramer CK, Moehlecke M, Pinto LC, Ricardo ED, Pinotti AF, Gross JL. Blood pressure means rather than nocturnal dipping pattern are related to complications in Type 2 diabetic patients. Diabet Med 2008; 25:308-13. [PMID: 18201207 DOI: 10.1111/j.1464-5491.2007.02354.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To determine whether systolic and diastolic blood pressure (BP) means, during ambulatory BP monitoring (ABPM), are more strongly correlated with microvascular complications and echocardiographic structural alterations than night-time/daytime (N/D) BP ratio. METHODS A cross-sectional study was conducted in 270 Type 2 diabetes mellitus (DM) outpatients who underwent clinical and laboratory investigations, urinary albumin excretion rate (UAER) determination, echocardiography, office and 24-h ABPM (Spacelabs 90207). RESULTS UAER, after multivariate adjustments, was associated with office BP (systolic: R(2)(a) 0.162, P < 0.001; diastolic: R(2)(a) 0.124, P < 0.001) and ABPM (24-h systolic: R(2)(a) 0.195, P < 0.001; 24-h diastolic: R(2)(a) 0.197, P < 0.001) but not with N/D BP ratios (systolic: R(2)(a) 0.062, P = 0.080; diastolic: R(2)(a) 0.063, P = 0.069). Similar results were observed for echocardiographic parameters. The presence of retinopathy was associated only with night-time BP values [systolic means: odds ratio (OR) 1.13, 95% confidence interval (CI) 1.03-1.24 and diastolic means: OR 1.21, CI 1.04-1.40 and N/D diastolic BP ratio > 0.90, OR 3.21, CI 1.65-6.25]. CONCLUSIONS UAER and echocardiographic structural alterations had more consistent correlations of a greater magnitude with systolic BP means than with N/D BP ratios. The nocturnal BP values appear to be more relevant for diabetic retinopathy. BP measurement in patients with Type 2 DM should take into account the 24-h period rather than focusing on a specific time span of BP homeostasis.
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Affiliation(s)
- C B Leitão
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Pearlman AS. Meeting the Needs of Our Readers. J Am Soc Echocardiogr 2008. [DOI: 10.1016/j.echo.2007.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mazraeshahi RM, Farmer JC, Porembka DT. A suggested curriculum in echocardiography for critical care physicians. Crit Care Med 2007; 35:S431-3. [PMID: 17667468 DOI: 10.1097/01.ccm.0000270280.65365.aa] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Echocardiography is a powerful diagnostic and monitoring tool of cardiac performance, cardiac pathology, and extracardiac intrathoracic abnormalities. Numerous investigations in intensive care have shown its merit, being efficacious and safe. Because many obvious and/or unsuspected conditions can impact the hemodynamic status of critically ill patients, echocardiography is becoming an integral part of an intensivist's diagnostic and monitoring armamentarium. However, significant background information, cognitive, and technical skills are required to properly perform and interpret echocardiography images. Some education and training guidelines for echocardiography have been developed while others remain "in progress." This manuscript suggests a core curriculum and necessary training elements for intensivists. This curriculum does not segregate portable handheld surface echocardiography from the typical platforms of transthoracic echocardiography and transesophageal echocardiography, because hardware and software developments have bridged these technologies.
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Stainback RF. Introduction to Echocardiography. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Lai WW, Geva T, Shirali GS, Frommelt PC, Humes RA, Brook MM, Pignatelli RH, Rychik J. Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr 2006; 19:1413-30. [PMID: 17138024 DOI: 10.1016/j.echo.2006.09.001] [Citation(s) in RCA: 572] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Wyman W Lai
- Mount Sinai Medical Center, New York, NY 10029, USA
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Béïque F, Ali M, Hynes M, MacKenzie S, Denault A, Martineau A, MacAdams C, Sawchuk C, Hirsch K, Lampa M, Murphy P, Honos G, Munt B, Sanfilippo A, Duke P. Canadian guidelines for training in adult perioperative transesophageal echocardiography. Recommendations of the Cardiovascular Section of the Canadian Anesthesiologists' Society and the Canadian Society of Echocardiography. Can J Cardiol 2006; 22:1015-27. [PMID: 17036096 PMCID: PMC2568962 DOI: 10.1016/s0828-282x(06)70317-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To establish Canadian guidelines for training in adult perioperative transesophageal echocardiography (TEE). METHODS Guidelines were established by the Canadian Perioperative Echocardiography Group with the support of the cardiovascular section of the Canadian Anesthesiologists' Society in conjunction with the Canadian Society of Echocardiography. Guidelines for training in echocardiography by the American Society of Echocardiography, the American College of Cardiology and the Society of Cardiovascular Anesthesiologists were reviewed, modified and expanded to produce the 2003 Quebec expert consensus for training in perioperative echocardiography. The Quebec expert consensus and the 2005 guidelines for the provision of echocardiography in Canada formed the basis of the Canadian training guidelines in adult perioperative TEE. RESULTS Basic, advanced and director levels of expertise were identified. The total number of echocardiographic examinations to achieve each level of expertise remains unchanged from the 2002 American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists guidelines. The increased proportion of examinations personally performed at basic and advanced levels, as well as the level of autonomy at the basic level suggested by the Quebec expert consensus are retained. These examinations may be performed in a perioperative setting and are not limited to intraoperative TEE. Training 'on-the-job', the role of the perioperative TEE examination, the requirements for maintenance of competence and the duration of training are also discussed for each level of training. The components of a TEE report and comprehensive TEE examination are also outlined. CONCLUSION The Canadian guidelines for training in adult perioperative TEE reflect the unique Canadian practice profile in perioperative TEE and address the training requirements to obtain expertise in this field.
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Affiliation(s)
- François Béïque
- Department of Anesthesia, Sir Mortimer B Davis Jewish General Hospital, McGill University, Montreal, Quebec
- Correspondence: Dr François Béïque, Sir Mortimer B Davis Jewish General Hospital, 3755 chemin de la Côte Ste-Catherine, Montreal, Quebec H3T 1E2. Telephone 514-340-8222 ext 5701, fax 514-340-8108, e-mail
| | - Mohamed Ali
- Department of Anesthesia and Surgery, Kingston General Hospital, Queen’s University, Kingston
| | - Mark Hynes
- Department of Anesthesia and Critical Care Medicine, Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario
| | - Scott MacKenzie
- Departments of Anesthesia and Medicine, St Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba
| | - André Denault
- Department of Anesthesiology, Montreal Heart Institute, University of Montreal, Montreal
- Department of Medicine, Critical Care Division, Montreal Heart Institute, University of Montreal, Montreal
| | - André Martineau
- Department of Anesthesia, Quebec Heart Institute/Laval Hospital, Laval University, Quebec City, Quebec
| | - Charles MacAdams
- Department of Anesthesia, Foothills Medical Centre, University of Calgary, Calgary, Alberta
| | - Corey Sawchuk
- Department of Anesthesia, McMaster University, Hamilton, Ontario
| | - Kristine Hirsch
- Department of Anesthesia, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia
| | - Martin Lampa
- Department of Anesthesia, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia
| | - Patricia Murphy
- Department of Anesthesia, Toronto General Hospital, University of Toronto, Toronto, Ontario
| | - Georges Honos
- Department of Medicine, Division of Cardiology, Sir Mortimer B Davis Jewish General Hospital, McGill University, Montreal, Quebec
| | - Bradley Munt
- Department of Medicine, Division of Cardiology, St Paul’s Hospital and Providence Health Care, University of British Columbia, Vancouver, British Columbia
| | - Anthony Sanfilippo
- Department of Medicine, Kingston General Hospital Queen’s University, Kingston, Ontario
| | - Peter Duke
- Departments of Anesthesia and Surgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba
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Béïque F, Ali M, Hynes M, MacKenzie S, Denault A, Martineau A, MacAdams C, Sawchuk C, Hirsch K, Lampa M, Murphy P, Honos G, Munt B, Sanfilippo A, Duke P. Canadian guidelines for training in adult perioperative transesophageal echocardiographyRecommendations of the Cardiovascular Section of the Canadian Anesthesiologists’ Society and the Canadian Society of Echocardiography. Can J Anaesth 2006; 53:1044-60. [PMID: 16987861 DOI: 10.1007/bf03022535] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To establish Canadian guidelines for training in adult perioperative transesophageal echocardiography (TEE). METHODS Guidelines were established by the Canadian Perioperative Echocardiography Group with the support of the cardiovascular section of the Canadian Anesthesiologists' Society (CAS) in conjunction with the Canadian Society of Echocardiography. Guidelines for training in echocardiography by the American Society of Echocardiography, the American College of Cardiology and the Society of Cardiovascular Anesthesiologists were reviewed, modified and expanded to produce the 2003 Quebec expert consensus for training in perioperative echocardiography. The Quebec expert consensus and the 2005 Guidelines for the provision of echocardiography in Canada formed the basis of the Canadian training guidelines in adult perioperative TEE. RESULTS Basic, advanced and director levels of expertise were identified. The total number of echocardiographic examinations to achieve each level of expertise remains unchanged from the 2002 American Society of Echocardiography-Society of Cardiovascular Anesthesiologists guidelines. The increased proportion of examinations personally performed at basic and advanced levels, and the level of autonomy at the basic level suggested by the Quebec expert consensus are retained. These examinations can be performed in a perioperative setting and are not limited to intraoperative TEE. Training "on the job", the role of the perioperative transesophageal echocardiography examination, requirements for maintenance of competence, and duration of training are also discussed for each level of training. The components of a TEE report and comprehensive TEE examination are also outlined. CONCLUSION The Canadian guidelines for training in adult perioperative TEE reflect the unique Canadian practice profile in perioperative TEE and address the training requirements to obtain expertise in this field.
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Affiliation(s)
- François Béïque
- SMBD Jewish General Hospital, 3755 chemin de la Côte Ste-Catherine, Montreal, Quebec H3T 1E2, Canada.
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Zanchetta M, Rigatelli G, Pedon L, Zennaro M, Dimopoulous K, Onorato E, Frescura C, Maiolino P, Thiene G, Angelini A. Intracardiac echocardiography: gross anatomy and magnetic resonance correlations and validations. Int J Cardiovasc Imaging 2005; 21:391-401. [PMID: 16047120 DOI: 10.1007/s10554-004-5809-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2004] [Accepted: 10/07/2004] [Indexed: 11/28/2022]
Abstract
PURPOSE The feasibility and safety of intracardiac echocardiography (ICE) in humans, using low frequency transducers, and its excellent tissue contrast capabilities that enhances the differentiation of intracardiac structures have been previously demonstrated. However, correlations among ICE imaging and anatomic sections or magnetic resonance (MR) scan planes have never been described before. This study was designed to correlate a simplified ICE approach with the anatomy of the right atrium and great vessels obtained by serial post-mortem sections and cardiac MR images. METHODS A stepwise approach to ICE, which is based on our experience on over 300 consecutive patients with interatrial communications, has been correlated with anatomic sections from pressure-perfused-fixed hearts and spin echo cardiac MR imaging. A 9F-9 MHz mechanical device was used to record four transverse and one longitudinal sections for an extensive evaluation of the intracardiac architecture. RESULTS ICE transverse and longitudinal views allowed the detection of all the required information. Moreover, the anatomic sections and cardiac MR scan planes allowed validation of all the structures imaged by ICE. The potential clinical applications of the ICE technique are further discussed. CONCLUSION This paper demonstrates the basic accuracy of this new imaging modality. Therefore, mechanical ICE might be considered an active investment in cardiac catheterization laboratories, specifically in the percutaneous interventional procedure setting, discovering a new route (let's see and treat) to sophisticated interventions. In this respect, there can be little doubt that the knowledge of cross-sectional mechanical ICE imaging provides the basis for understanding the heart anatomy.
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Affiliation(s)
- Mario Zanchetta
- Department Cardiovascular Disease, Cittadella General Hospital, Padova, Cittadella, Italy.
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Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, Morehead A, Kitzman D, Oh J, Quinones M, Schiller NB, Stein JH, Weissman NJ. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 2005; 17:1086-119. [PMID: 15452478 DOI: 10.1016/j.echo.2004.07.013] [Citation(s) in RCA: 329] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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