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Holte E, Podlesnikar T, Carvalho F, Demirkiran A, Manka R, Martínez GG, Michalski B, Pasquet Separovic A, Soliman-Aboumarie H, Shruti JS, Haugaa KH, Dweck MR. European Association of Cardiovascular Imaging survey on the evaluation of mitral regurgitation. Eur Heart J Cardiovasc Imaging 2024; 25:573-578. [PMID: 38387435 PMCID: PMC11057920 DOI: 10.1093/ehjci/jeae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
AIMS To evaluate the diagnosis and imaging of patients with mitral regurgitation (MR) and the management in routine clinical practice across Europe, the European Association of Cardiovascular Imaging Scientific Initiatives Committee performed a survey across European centres. In particular, the routine use of echocardiography, advanced imaging modalities, heart valve clinics, and heart valve teams was explored. METHODS AND RESULTS A total of 61 responders, mainly from tertiary centres or university hospitals, from 26 different countries responded to the survey, which consisted of 22 questions. For most questions related to echocardiography and advanced imaging, the answers were relatively homogeneous and demonstrated good adherence to current recommendations. In particular, the centres used a multi-parametric echocardiographic approach and selected the effective regurgitant orifice and vena contracta width as their preferred assessments. 2D measurements are still the most widely used parameters to assess left ventricular structure; however, the majority use 3D trans-oesophageal echocardiography (TOE) to evaluate valve morphology in severe MR. The majority of centres reported the onsite availability and clinical use of ergometric stress echocardiography, cardiac computed tomography (CCT), and cardiac magnetic resonance (CMR) imaging. Heart valve clinics and heart valve teams were also widely prevalent. CONCLUSION Consistent with current guidelines, echocardiography (transthoracic echocardiography and TOE) remains the first-line and central imaging modality for the assessment of MR although the complementary use of 3D TOE, CCT, and CMR appears to be growing. Heart valve clinics and heart valve teams are now widely prevalent.
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Affiliation(s)
- Espen Holte
- Clinic of Cardiology, St. Olavs Hospital, Postboks 3250 Torgarden, Trondheim 7006, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology NTNU, Postboks 8905, Trondheim 7491, Norway
| | - Tomaž Podlesnikar
- University Medical Centre Maribor, Slovenia
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Fontes Carvalho
- Cardiovascular Research and Development Unit (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ahmet Demirkiran
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
- Department of Cardiology, Kocaeli Şehir Medical Center, Tavşantepe, İzmit/Kocaeli 41060, Türkiye
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Gabriela Guzmán Martínez
- Department of Cardiology, Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Błażej Michalski
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Agnès Pasquet Separovic
- Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, IREC/CARD UCLouvain, Brussels B-1200, Belgium
| | - Hatem Soliman-Aboumarie
- Department of Cardiothoracic Critical Care, Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield Hospitals, London, UK
- School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, London, UK
| | - Joshi S Shruti
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Kristina H Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, Oslo 0424, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Kuo MYW, Häggström J, Gordon SG, Höglund K, Côté E, Lu TL, Dirven M, Rishniw M, Hung YW, Ljungvall I. Veterinary echocardiographers' preferences for left atrial size assessment in dogs: the BENEFIT project. J Vet Cardiol 2023; 51:157-171. [PMID: 38128421 DOI: 10.1016/j.jvc.2023.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/13/2023] [Accepted: 11/05/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION/OBJECTIVES Veterinary echocardiographers' preferences for left atrial (LA) size assessment in dogs have never been systematically investigated. The primary aim of this international survey study was to investigate echocardiographers' preferences for LA size assessment in dogs. The secondary aim was to investigate echocardiographers' preferences for assessing LA size in subgroups based on geographic, demographic, and professional profiles. ANIMALS, MATERIALS, AND METHODS An online survey instrument was designed, verified, and distributed globally to the veterinary echocardiographers. RESULTS A total of 670 echocardiographers from 54 countries on six continents completed the survey. Most echocardiographers (n = 621) used linear two-dimensional (2D)-based methods to assess LA size, 379 used subjective assessment, and 151 used M-mode-based methods. Most commonly, echocardiographers combined linear 2D-based methods with subjective assessment (n = 222), whereas 191 used linear 2D-based methods alone. Most echocardiographers (n = 436) using linear 2D-based methods preferred the right parasternal short-axis view and indexed the LA to the aorta. Approximately 30% (n = 191) of the echocardiographers who performed linear measurements from 2D echocardiograms shared the same preferences regarding dog position, acquisition view, indexing method, and identification of the time-point used for the measurement. The responses were comparably homogeneous across geographic location, training level, years of performing echocardiography, and type of practice. DISCUSSION/CONCLUSION Most veterinary echocardiographers assessed LA size in dogs using linear 2D echocardiography from a right parasternal short-axis view, and by indexing the LA to the aorta. The respondents' preferences were similar across geographic, demographic, and professional backgrounds.
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Affiliation(s)
- M Y-W Kuo
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden.
| | - J Häggström
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - S G Gordon
- Department of Small Animal Clinical Science, Texas A&M University, College Station, TX, USA
| | - K Höglund
- Department of Anatomy, Physiology and Biochemistry, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - E Côté
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Prince Edward Island, Canada
| | - T-L Lu
- Chuan Animal Hospital, Taipei, Taiwan
| | - M Dirven
- Evidensia Södra Animal Hospital, Kungens Kurva, Sweden
| | - M Rishniw
- Veterinary Information Network, Davis, CA, USA
| | - Y-W Hung
- Cardiospecial Veterinary Hospital, Taipei, Taiwan
| | - I Ljungvall
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Kuo MYW, Häggström J, Gordon SG, Höglund K, Côté E, Lu TL, Dirven M, Rishniw M, Hung YW, Ljungvall I. Veterinary echocardiographers' preferences for left atrial size assessment in cats: the BENEFIT project. J Vet Cardiol 2023; 51:145-156. [PMID: 38128420 DOI: 10.1016/j.jvc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 10/13/2023] [Accepted: 11/05/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION/OBJECTIVES Veterinary echocardiographers' preferences for left atrial (LA) size assessment in cats have not been systematically investigated. The primary aim of this prospective exploratory study was to investigate echocardiographers' preferences concerning LA size assessment in cats. A secondary aim was to investigate echocardiographers' preferences for assessing LA size in subgroups based on geographic, demographic, and professional profiles. ANIMALS, MATERIALS, AND METHODS An online survey instrument was designed, verified, and distributed globally to veterinary echocardiographers. RESULTS A total of 655 veterinary echocardiographers from six continents and 54 countries, working in specialty practice (56%) and in general practice (38%), provided data. Linear two-dimensional (2D) technique was favored by most echocardiographers (n = 612) for LA size assessment. Most commonly, respondents combined linear 2D with subjective assessment (n = 227), while 209 used linear 2D-based methods alone. Most echocardiographers using linear 2D-based methods preferred the right parasternal short-axis view and to index the LA to the aorta (Ao). Approximately 10% of the respondents obtained LA dimensions from a right parasternal long-axis four-chamber view. Approximately one-third of echocardiographers that made linear measurements from 2D echocardiograms shared the same preferences regarding cat position, acquisition view, indexing method and time point identification for the LA measurement. The responses were comparably homogeneous across geographic location, level of training, years performing echocardiography, and type of practice. DISCUSSION/CONCLUSION Most veterinary echocardiographers assessed LA size in cats using linear 2D echocardiography from a right parasternal short-axis view, and indexed LA to Ao. Respondents' preferences were similar over geographic, demographic, and professional backgrounds.
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Affiliation(s)
- M Y-W Kuo
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden.
| | - J Häggström
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - S G Gordon
- Department of Small Animal Clinical Science, Texas A&M University, College Station, TX, USA
| | - K Höglund
- Department of Anatomy, Physiology and Biochemistry, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - E Côté
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Prince Edward Island, Canada
| | - T-L Lu
- Chuan Animal Hospital, Taipei, Taiwan
| | - M Dirven
- Evidensia Södra Animal Hospital, Kungens Kurva, Sweden
| | - M Rishniw
- Veterinary Information Network, Davis, CA, USA
| | - Y-W Hung
- Cardiospecial Veterinary Hospital, Taipei, Taiwan
| | - I Ljungvall
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Keeping Up with Cardiac CT: A Call to Action for Cardiology Fellowship Training. J Cardiovasc Comput Tomogr 2022; 16:355-357. [DOI: 10.1016/j.jcct.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/25/2022] [Accepted: 04/14/2022] [Indexed: 11/22/2022]
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Podlesnikar T, Cardim N, Ajmone Marsan N, D'Andrea A, Cameli M, Popescu BA, Schulz-Menger J, Stankovic I, Toplisek J, Maurer G, Haugaa KH, Dweck MR. EACVI survey on hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021; 23:590-597. [PMID: 34957501 DOI: 10.1093/ehjci/jeab270] [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: 10/04/2021] [Accepted: 12/03/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey to evaluate current practice for the assessment and management of patients with hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS A total of 213 centres from 38 different countries (87% European) responded to the survey. One hundred twenty-one (57%) centres followed HCM patients in a general cardiology outpatient clinic and 85 (40%) centres in a specialized HCM/cardiomyopathy clinic. While echocardiography was the primary imaging modality, cardiovascular magnetic resonance (CMR) has become an important complementary tool. Cardiac anatomy, left ventricular (LV) systolic, and diastolic function were assessed according to current European guidelines and recommendations. To evaluate LV obstruction, 49% of the centres performed bedside provocation manoeuvres in every patient and 55% of the centres used exercise stress echocardiography. The majority of centres used the 5-year risk assessment of sudden cardiac death (SCD) calculated with the HCM Risk-SCD score. However, 34% of the centres also used extensive non-infarct late gadolinium enhancement on CMR and 27% the presence of LV apical aneurysm to help select patients for primary prevention implantable cardioverter-defibrillator therapy. Ninety-nine percent of the responding centres performed regular imaging follow-up of HCM patients. CONCLUSION Most centres followed European guidelines and recommendations for the diagnosis and management of patients with HCM. The importance of bedside provocation manoeuvres and exercise stress echocardiography to diagnose LV outflow obstruction requires emphasis. Additional risk markers for SCD are used in many centres and might indicate the need for an update of current European recommendations.
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Affiliation(s)
- Tomaz Podlesnikar
- Department of Cardiac Surgery, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia.,Department of Cardiology, University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia
| | - Nuno Cardim
- Department of Cardiology, Hospital da Luz-Lisbon, Lisbon, Portugal.,Nova Medical School, Lisbon, Portugal
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital, Luigi Vanvitelli University - Nocera Inferiore (ASL Salerno), Viale San Francesco - 84014 Caserta, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila', Euroecolab, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
| | - Jeanette Schulz-Menger
- Charité ECRC Medical Faculty of the Humboldt University Berlin and Helios-Clinics, 13125 Berlin, Germany.,DZHK, Partnersite Berlin, Berlin, Germany
| | - Ivan Stankovic
- Department of Cardiology, Faculty of Medicine, Clinical Hospital Centre Zemun, University of Belgrade, 11080 Belgrade, Serbia
| | - Janez Toplisek
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia
| | - Gerald Maurer
- Division of Cardiology, Medical University of Vienna, Wahringer Gurtel 18-20, 1090 Wien, Austria
| | - Kristina H Haugaa
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, 0424 Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Blindern, 0318 Oslo, Norway
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh EH16 4SB, UK
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Stankovic I, Dweck MR, Marsan NA, Bergler-Klein J, Holte E, Manka R, Schulz-Menger J, Sitges M, Haugaa KH. The EACVI survey on cardiac imaging in cardio-oncology. Eur Heart J Cardiovasc Imaging 2021; 22:367-371. [PMID: 32464650 DOI: 10.1093/ehjci/jeaa111] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/22/2020] [Indexed: 12/22/2022] Open
Abstract
Early and late cardiovascular (CV) toxicities related to many cancer treatments may complicate the clinical course of patients, offsetting therapeutic benefits, and altering prognosis. The early detection, monitoring, and treatment of cardiotoxicity have therefore become essential parts of cancer patient care. CV imaging is a cornerstone of every cardio-oncology unit, but its use may vary across Europe because of the non-uniform availability of advanced imaging techniques and differences in the organization and logistics of cardio-oncology services. The purpose of this EACVI survey in cardio-oncology is to obtain real-world data on the current usage of cardiac imaging in cancer patients. Data from 104 centres and 35 different countries confirmed that cardiac imaging plays a pivotal role in the detection and monitoring of cardiac toxicity in oncology patients in Europe and beyond. However, it also revealed gaps between guidelines recommendations and everyday clinical practice, highlighting some of the challenges that need to be overcome in this rapidly advancing field.
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Affiliation(s)
- Ivan Stankovic
- Faculty of Medicine, Department of Cardiology, Clinical Hospital Centre Zemun, University of Belgrade, Vukova 9, 11080 Belgrade, Serbia
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Jutta Bergler-Klein
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, AKH General Hospital Vienna, Waehringer Guertel 18-20, A-1090, Vienna
| | - Espen Holte
- Clinic of Cardiology, St. Olavs Hospital, Postboks 3250 Torgarden, 7006 Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology NTNU, Trondheim, Postboks 8905, 7491, Trondheim, Norway
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Jeanette Schulz-Menger
- Charité Medical Faculty, of the Humboldt University Berlin, ECRC, 13125, Berlin, Germany.,DZHK, Partner site, 13125 Berlin, Germany.,Helios Clinics Berlin-Buch, Cardiology, 13125, Berlin, Germany
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Sinesio Delgado, 4, 28029, Madrid, Spain
| | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Postboks 1171, Blindern, 0318 Oslo, Norway
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D'Andrea A, Dweck MR, Holte E, Fontes-Carvalho R, Cameli M, Aboumarie HS, Diener HC, Haugaa KH. EACVI survey on the management of patients with patent foramen ovale and cryptogenic stroke. Eur Heart J Cardiovasc Imaging 2021; 22:135-141. [PMID: 33346351 DOI: 10.1093/ehjci/jeaa318] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey to evaluate the current practice for the assessment and management of patients with suspected patent foramen ovale (PFO) and cryptogenic stroke. METHODS AND RESULTS In total, 79 imaging centres from 34 countries across the world responded to the survey, which comprised 17 questions. Most non-invasive investigations for PFO were widely available in the responding centres, with the exception of transcranial colour Doppler which was only available in 70% of sites, and most commonly performed by neurologists. Standard transthoracic echocardiography, with or without bubbles, was considered the first-level test for suspected PFO in the majority of the centres, whereas transoesophageal echocardiography was an excellent second-level modality. Most centres would rule out atrial fibrillation (AF) as a source of embolism in all patients with cryptogenic stroke (63%), with the remainder reserving investigation for patients with multiple AF risk factors (33%). Cardiac magnetic resonance was the preferred tool for identifying other unusual aetiologies, like cardiac masses or thrombi. After PFO closure, there was variation in the use of antiplatelet therapy: a quarter recommended treatment for life, while only 12% recommended 5 years as stipulated in the guidelines (12%). Antibiotic prophylaxis prior to dental or endoscopic procedures was not recommended in 41% of centres, contrary to what the guidelines recommended. CONCLUSION Our survey revealed a variable adherence to the current recommendations for the diagnosis and management of patients with cryptogenic stroke and PFO. Efforts should focus on optimizing and standardizing diagnostic tests and treatment of this condition.
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Affiliation(s)
- Antonello D'Andrea
- Department of Cardiology, Umberto I_ Hospital, Luigi Vanvitelli University - Nocera Inferiore (ASL Salerno), Viale San Francesco - 84014 Caserta, Italy
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, Department of Cardiology, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Espen Holte
- Department of Cardiology, St. Olavs Hospital, Postboks 3250 Torgarden, 7006 Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology NTNU, Trondheim, PO Box 8905, 7491 Trondheim, Norway
| | - Ricardo Fontes-Carvalho
- Cardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Policlinico Le Scotte, Viale Bracci 16, 53100 Siena, Italy
| | - Hatem Soliman Aboumarie
- Department of Cardiology - Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, UB9 6JH London, UK
| | - Hans Christoph Diener
- Department of Neurology - Medical Faculty of the University Duisburg-Essen-Institute for Medical Informatics, Biometry and Epidemiology, Hufelandstraße, 26, 45147 Essen, Germany
| | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway.,Department of Cardiology - Institute for Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway
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8
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Bularga A, Saraste A, Fontes-Carvalho R, Holte E, Cameli M, Michalski B, Williams MC, Podlesnikar T, D'Andrea A, Stankovic I, Mills NL, Manka R, Newby DE, Schultz-Menger J, Haugaa KH, Dweck MR. EACVI survey on investigations and imaging modalities in chronic coronary syndromes. Eur Heart J Cardiovasc Imaging 2021; 22:1-7. [PMID: 33165600 PMCID: PMC7758034 DOI: 10.1093/ehjci/jeaa300] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 01/08/2023] Open
Abstract
Aims The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey to evaluate current practice for the assessment and management of patients with suspected and confirmed chronic coronary syndromes. Methods and results One-hundred and ten imaging centres from 37 countries across the world responded to the survey. Most non-invasive investigations for coronary artery disease were widely available, except cardiovascular magnetic resonance (available 40% centres). Coronary computed tomography angiography (CCTA) and nuclear scans were reported by a multi-disciplinary team in only a quarter of centres. In the initial assessment of patients presenting with chest pain, only 32% of respondents indicated that they rely on pre-test probability for selecting the optimal imaging test while 31% proceed directly to CCTA. In patients with established coronary artery disease and recurrent chest pain, respondents opted for stress echocardiography (27%) and nuclear stress perfusion scans (26%). In asymptomatic patients with coronary artery disease and an obstructive (>70%) right coronary artery stenosis, 58% of respondents were happy to pursue medical therapy without further testing or intervention. This proportion fell to 29% with left anterior descending artery stenosis and 1% with left main stem obstruction. In asymptomatic patients with evidence of moderate-to-severe myocardial ischaemia (15%), only 18% of respondents would continue medical therapy without further investigation. Conclusion Despite guidelines recommendations pre-test probability is used to assess patients with suspected coronary artery in a minority of centres, one-third of centres moving directly to CCTA. Clinicians remain reticent to pursue a strategy of optimal medical therapy without further investigation or intervention in patients with controlled symptoms but obstructive coronary artery stenoses or myocardial ischaemia.
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Affiliation(s)
- Anda Bularga
- BHF Centre for Cardiovascular Science, Department of Cardiology, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Antti Saraste
- Edinburgh, EH16 4SB, Heart Center, Turku University Hospital, Turku, 20520, Finland
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Cardiovascular Research and Development Unit (UnIC), Faculty of Medicine, University of Porto, Porto, 4200-319, Portugal
| | - Espen Holte
- Department of Cardiology, St. Olavs Hospital, Trondheim, 7006, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology NTNU, Trondheim, 7006, Norway
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, 53100, Italy
| | - Blazej Michalski
- Department of Cardiology, Medical University of Lodz, Lodz, 91-347, Poland
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, Department of Cardiology, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Tomaz Podlesnikar
- Department of Cardiac Surgery, University Medical Centre Maribor, Maribor, 2000, Slovenia
| | - Antonello D'Andrea
- Unit of Cardiology, Department of Translational Medical Sciences, Monaldi Hospital, University of Campania 'Luigi Vanvitelli', Naples, 80121, Italy
| | - Ivan Stankovic
- Faculty of Medicine, Department of Cardiology, Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, 11080, Serbia
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, Department of Cardiology, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, 8091, Switzerland
| | - David E Newby
- BHF Centre for Cardiovascular Science, Department of Cardiology, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Jeanette Schultz-Menger
- Department of Cardiology and Nephrology, Charité Medical Faculty of the Humboldt University Berlin, Berlin, 13125, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, 13125, Germany.,Helios Clinics Berlin-Buch, Department of Cardiology, Berlin, 13125, Germany
| | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital, Oslo, 0424, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, 0318, Norway
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, Department of Cardiology, University of Edinburgh, Edinburgh, EH16 4SB, UK
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9
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Holte E, Dweck MR, Marsan NA, D'Andrea A, Manka R, Stankovic I, Haugaa KH. EACVI survey on the evaluation of infective endocarditis. Eur Heart J Cardiovasc Imaging 2021; 21:828-832. [PMID: 32361725 PMCID: PMC7369685 DOI: 10.1093/ehjci/jeaa066] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/23/2020] [Indexed: 12/14/2022] Open
Abstract
Aims To evaluate the diagnosis and imaging of patients with suspected endocarditis and the management in routine clinical practice across Europe, the EACVI Scientific Initiatives Committee performed a survey across European centres. In particular, the routine use of echocardiography, advanced imaging modalities and multidisciplinary team was explored. Methods and results A total of 100 European Echocardiography Laboratories from 29 different countries responded to the survey, which consisted of 20 questions. For most of the use of echocardiography and advanced imaging, answers from the centres were relatively homogeneous and demonstrated good adherence to current recommendations. In particular, two-thirds of centres report the use of a specific endocarditis team for decision-making. Echocardiography plays a key role in the diagnosis and management of endocarditis. Nuclear imaging modalities are broadly available among the centres and are mainly used in prosthetic valve endocarditis and cardiac device-related infective endocarditis. Computed tomography (CT) is widely available and used to assess for structural valve abnormalities, neurological complications, and to preoperative assessment of the coronary arteries. Most institutions provide structured patients follow-up following hospital discharge. Conclusion In Europe, a relatively homogenous adherence to current recommendation was observed for most diagnostic and management including the follow-up of patients with endocarditis. Decision-making is most commonly performed by a multidisciplinary team. Echocardiography remains the first line and central imaging modality for patient diagnosis and assessment, but 60% of centres also commonly use CT, whilst positron emission tomography imaging is used in patients with prosthetic valve endocarditis or device infection.
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Affiliation(s)
- Espen Holte
- Clinic of Cardiology, St. Olavs Hospital, PO Box 3250, Torgarden, 7006 Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology NTNU, Trondheim, PO Box 8905, 7491 Trondheim, Norway
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10
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Michalski B, Dweck MR, Marsan NA, Cameli M, D'Andrea A, Carvalho RF, Holte E, Podlesnikar T, Manka R, Haugaa KH. The evaluation of aortic stenosis, how the new guidelines are implemented across Europe: a survey by EACVI. Eur Heart J Cardiovasc Imaging 2021; 21:357-362. [PMID: 32196100 DOI: 10.1093/ehjci/jeaa009] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/11/2020] [Indexed: 12/27/2022] Open
Abstract
Aortic stenosis (AS) is the most prevalent valvular disease in developed countries, with a prevalence that is set to expand further with an ageing population. The most recent guidelines on valvular heart disease published by the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery, aim to standardize the diagnosis and management of valvular heart diseases. The imaging criteria of the current guidelines are mostly based on EACVI Recommendations, with an appropriate diagnostic workflow being of major importance, to ensure streamlined and efficient patient assessment and accurate diagnoses and decisions regarding the timing of surgery. The EACVI Scientific Initiatives Committee, therefore, created a survey on the imaging assessment of patient with AS to investigate the diagnostic patient pathways used in different centres across Europe. In particular, we conducted this survey to better understand the use and access of advanced imaging techniques in AS including 3D transthoracic echocardiography and 3D transoesophageal echocardiography, cardiac computed tomography, and cardiovascular magnetic resonance.
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Affiliation(s)
- Blazej Michalski
- Department of Cardiology, Medical University of Lodz, Kniaziewicza 1/5, 91-347 Lodz, Poland
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh EH16 4SB, UK
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Policlinico Le Scotte, Viale Bracci 16, 53100 Siena, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I_ Hospital, Viala San Francesco 84014 Nocera Inferiore (Salerno), Luigi Vanvitelli University, Italy
| | - Ricardo Fontes Carvalho
- Cardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Espen Holte
- Clinic of Cardiology, St. Olavs Hospital, Postboks 3250 Torgarden, 7006 Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology NTNU, Trondheim, Postboks 8905, 7491 Trondheim, Norway
| | - Tomaz Podlesnikar
- Department of Cardiac Surgery, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia.,Department of Cardiology, University Medical Centre Ljubljana, Zaloska cesta 7, 1000 Ljubljana, Slovenia
| | | | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway
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11
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Edvardsen T, Haugaa KH, Petersen SE, Gimelli A, Donal E, Maurer G, Popescu BA, Cosyns B. The year 2019 in the European Heart Journal-Cardiovascular Imaging: Part I. Eur Heart J Cardiovasc Imaging 2020; 21:1208-1215. [PMID: 32929466 DOI: 10.1093/ehjci/jeaa259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022] Open
Abstract
The European Heart Journal-Cardiovascular Imaging was launched in 2012 and has during these years become one of the leading multimodality cardiovascular imaging journals. The journal is now established as one of the top cardiovascular journals and is the most important cardiovascular imaging journal in Europe. The most important studies published in our Journal in 2019 will be highlighted in two reports. Part I of the review will focus on studies about myocardial function and risk prediction, myocardial ischaemia, and emerging techniques in cardiovascular imaging, while Part II will focus on valvular heart disease, heart failure, cardiomyopathies, and congenital heart disease.
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Affiliation(s)
- Thor Edvardsen
- Department of Cardiology, Centre of Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Postbox 4950 Nydalen, Sognsvannsveien 20, NO-0424 Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Postboks 1171, Blindern 0318 Oslo, Norway
| | - Kristina H Haugaa
- Department of Cardiology, Centre of Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Postbox 4950 Nydalen, Sognsvannsveien 20, NO-0424 Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Postboks 1171, Blindern 0318 Oslo, Norway
| | - Steffen E Petersen
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, EC1A 7BE, London, UK.,William Harvey Research Institute, Queen Mary University of London, EC1M 6BQ, London, UK
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio via Moruzzi n.1 - 56124 - Pisa, Italy
| | - Erwan Donal
- Cardiology and CIC-IT1414, CHU Rennes, Rennes, France.,LTSI INSERM 1099, University Rennes-1, Rennes, France
| | - Gerald Maurer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Wien, Austria
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, Sector 2, 022328 Bucharest, Romania
| | - Bernard Cosyns
- Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair Ziekenhuis Brussel, 109 Laarbeeklaan, B1090 Brussels, Belgium
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12
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Dweck MR, Bularga A, Hahn RT, Bing R, Lee KK, Chapman AR, White A, Salvo GD, Sade LE, Pearce K, Newby DE, Popescu BA, Donal E, Cosyns B, Edvardsen T, Mills NL, Haugaa K. Global evaluation of echocardiography in patients with COVID-19. Eur Heart J Cardiovasc Imaging 2020; 21:949-958. [PMID: 32556199 PMCID: PMC7337658 DOI: 10.1093/ehjci/jeaa178] [Citation(s) in RCA: 271] [Impact Index Per Article: 67.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/02/2020] [Indexed: 01/08/2023] Open
Abstract
Aims To describe the cardiac abnormalities in patients with COVID-19 and identify the characteristics of patients who would benefit most from echocardiography. Methods and results In a prospective international survey, we captured echocardiography findings in patients with presumed or confirmed COVID-19 between 3 and 20 April 2020. Patient characteristics, indications, findings, and impact of echocardiography on management were recorded. Multivariable logistic regression identified predictors of echocardiographic abnormalities. A total of 1216 patients [62 (52–71) years, 70% male] from 69 countries across six continents were included. Overall, 667 (55%) patients had an abnormal echocardiogram. Left and right ventricular abnormalities were reported in 479 (39%) and 397 (33%) patients, respectively, with evidence of new myocardial infarction in 36 (3%), myocarditis in 35 (3%), and takotsubo cardiomyopathy in 19 (2%). Severe cardiac disease (severe ventricular dysfunction or tamponade) was observed in 182 (15%) patients. In those without pre-existing cardiac disease (n = 901), the echocardiogram was abnormal in 46%, and 13% had severe disease. Independent predictors of left and right ventricular abnormalities were distinct, including elevated natriuretic peptides [adjusted odds ratio (OR) 2.96, 95% confidence interval (CI) 1.75–5.05) and cardiac troponin (OR 1.69, 95% CI 1.13–2.53) for the former, and severity of COVID-19 symptoms (OR 3.19, 95% CI 1.73–6.10) for the latter. Echocardiography changed management in 33% of patients. Conclusion In this global survey, cardiac abnormalities were observed in half of all COVID-19 patients undergoing echocardiography. Abnormalities were often unheralded or severe, and imaging changed management in one-third of patients.
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Affiliation(s)
- Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Anda Bularga
- Centre for Cardiovascular Science, University of Edinburgh, UK
| | | | - Rong Bing
- Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Kuan Ken Lee
- Centre for Cardiovascular Science, University of Edinburgh, UK
| | | | - Audrey White
- Centre for Cardiovascular Science, University of Edinburgh, UK
| | | | - Leyla Elif Sade
- Department of Cardiology, University of Baskent, Ankara, Turkey
| | - Keith Pearce
- University Hospital South Manchester, Cardiology, Wythenshawe, Manchester, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bucharest, Romania
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
| | - Bernard Cosyns
- Centrum voor Hart en Vaatziekten, Universitair Ziekenhuis Brussel, Vrij Universiteit van Brussel, Brussels, Belgium
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nicholas L Mills
- Centre for Cardiovascular Science, University of Edinburgh, UK.,Usher Institute, University of Edinburgh, UK
| | - Kristina Haugaa
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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