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1. Stress echo in Italy

Author

Ciampi, Quirino, Citro, Rodolfo, Severino, Sergio, Labanti, Graziana, Cortigiani, Lauro, Sicari, Rosa, Gaibazzi, Nicola, Galderisi, Maurizio, Bossone, Eduardo, Colonna, Paolo, Picano, Eugenio, D'Andrea, Antonello, Scali, Maria Chiara, Olivotto, Iacopo, Mori, Fabio, Costantino, Marco Fabio, Pratali, Lorenza, Di Salvo, Giovanni, Ferrara, Francesco, Gargani, Luna, Rigo, Fausto, Limongelli, Giuseppe, Pacileo, Giuseppe, Andreassi, Maria Grazia, Pinamonti, Bruno, Massa, Laura, Torres, Marco A. R., Miglioranza, Marcelo H., Daros, Clarissa Borguezan, De Castro E Silva Pretto, José Luis, Beleslin, Branko, Djordjevic-DIkic, Ana, Varga, Albert, Palinkas, Attila, Agoston, Gergely, Gregori, Dario, Trambaiolo, Paolo, Arystan, Ayana, Paterni, Marco, Carpeggiani, Clara, Ciampi, Quirino, Citro, Rodolfo, Severino, Sergio, Labanti, Graziana, Cortigiani, Lauro, Sicari, Rosa, Gaibazzi, Nicola, Galderisi, Maurizio, Bossone, Eduardo, Colonna, Paolo, Picano, Eugenio, D'Andrea, Antonello, Scali, Maria Chiara, Olivotto, Iacopo, Mori, Fabio, Costantino, Marco Fabio, Pratali, Lorenza, Di Salvo, Giovanni, Ferrara, Francesco, Gargani, Luna, Rigo, Fausto, Limongelli, Giuseppe, Pacileo, Giuseppe, Andreassi, Maria Grazia, Pinamonti, Bruno, Massa, Laura, Torres, Marco A. R., Miglioranza, Marcelo H., Daros, Clarissa Borguezan, De Castro E Silva Pretto, José Lui, Beleslin, Branko, Djordjevic-DIkic, Ana, Varga, Albert, Palinkas, Attila, Agoston, Gergely, Gregori, Dario, Trambaiolo, Paolo, Arystan, Ayana, Paterni, Marco, and Carpeggiani, Clara

Subjects
medicine.medical_specialty, business.industry, Myocardial Ischemia, MEDLINE, General Medicine, 030204 cardiovascular system & hematology, Stress, Echocardiography, Stress, Humans, Italy, Practice Guidelines as Topic, Societies, Medical, Cardiology and Cardiovascular Medicine, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, Echocardiography, Stress Echo, Medical, Medicine, 030212 general & internal medicine, State (computer science), Societies, business
Published
2017

2. B-lines with Lung Ultrasound: The Optimal Scan Technique at Rest and During Stress

Author

Maria Chiara Scali, Angela Zagatina, Iana Simova, Nadezhda Zhuravskaya, Quirino Ciampi, Marco Paterni, Mario Marzilli, Clara Carpeggiani, Eugenio Picano, Rodolfo Citro, Antonello D'Andrea, Lauro Cortigiani, Iacopo Olivotto, Fabio Mori, Maurizio Galderisi, Marco Fabio Costantino, Lorenza Pratali, Giovanni di Salvo, Eduardo Bossone, Francesco Ferrara, Jaroslaw D. Kasprszak, Fausto Rigo, Nicola Gaibazzi, Giuseppe Limongelli, Giuseppe Pacileo, Sergio Severino, Bruno Pinamonti, Laura Massa, Marco A.R. Torres, Marcelo H. Miglioranza, Clarissa Borguezan Daros, José Luis de Castro e Silva Pretto, Ana Djordjevic-Dikic, Milica Dekleva, Albert Varga, Gergely Agoston, Attila Palinkas, Miguel Amor, Jorge Lowenstein, Pablo Merlo, Jelena Celutkiene, Julio E. Perez, Paolo Trambaiolo, Dario Gregori, Paolo Colonna, Maria Grazia Andreassi, Michele De Nes, Ayana Arystan, Scali, Maria Chiara, Zagatina, Angela, Simova, Iana, Zhuravskaya, Nadezhda, Ciampi, Quirino, Paterni, Marco, Marzilli, Mario, Carpeggiani, Clara, Picano, Eugenio, Citro, Rodolfo, D'Andrea, Antonello, Cortigiani, Lauro, Olivotto, Iacopo, Mori, Fabio, Galderisi, Maurizio, Costantino, Marco Fabio, Pratali, Lorenza, di Salvo, Giovanni, Bossone, Eduardo, Ferrara, Francesco, Kasprszak, Jaroslaw D., Rigo, Fausto, Gaibazzi, Nicola, Limongelli, Giuseppe, Pacileo, Giuseppe, Severino, Sergio, Pinamonti, Bruno, Massa, Laura, Torres, Marco A. R., Miglioranza, Marcelo H., Daros, Clarissa Borguezan, Luis de Castro e Silva Pretto, José, Djordjevic-Dikic, Ana, Dekleva, Milica, Varga, Albert, Agoston, Gergely, Palinkas, Attila, Amor, Miguel, Lowenstein, Jorge, Merlo, Pablo, Celutkiene, Jelena, Perez, Julio E., Trambaiolo, Paolo, Gregori, Dario, Colonna, Paolo, Andreassi, Maria Grazia, De Nes, Michele, and Arystan, Ayana

Subjects
Male, medicine.medical_specialty, Acoustics and Ultrasonics, Stre, Rest, Physiological, Biophysics, 030204 cardiovascular system & hematology, Stress, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Stress, Physiological, medicine, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, 030212 general & internal medicine, Exercise, Lung, Rest (music), Ultrasonography, Water, Extravascular Lung Water, Female, Middle Aged, Exercise Test, Radiological and Ultrasound Technology, business.industry, Ultrasound, Exercise stress, medicine.disease, Lung ultrasound, Surgery, medicine.anatomical_structure, Lung water, Biophysic, Parasternal line, business, Nuclear medicine
Abstract

Various lung ultrasound (LUS) scanning modalities have been proposed for the detection of B-lines, also referred to as ultrasound lung comets , which are an important indication of extravascular lung water at rest and after exercise stress echo (ESE). The aim of our study was to assess the lung water spatial distribution ( comet map ) at rest and after ESE. We performed LUS at rest and immediately after semi-supine ESE in 135 patients (45 women, 90 men; age 62 ± 12 y, resting left ventricular ejection fraction = 41 ± 13%) with known or suspected heart failure or coronary artery disease. B-lines were measured by scanning 28 intercostal spaces (ISs) on the antero-lateral chest, 2nd–5th IS, along with the midaxillary (MA), anterior axillary (AA), mid-clavicular (MC) and parasternal (PS) lines. Complete 28-region, 16-region (3rd and 4th IS), 8-region (3rd IS), 4-region (3rd IS, only AA and MA) and 1-region (left 3rd IS, MA) scans were analyzed. In each space, the B-lines were counted from 0 = black lung to 10 = white lung. Interpretable images were obtained in all spaces (feasibility = 100 %). B-lines (>0 in at least 1 space) were present at ESE in 93 patients (69%) and absent in 42. More B-lines were found in the 3rd IS and along AA and MA lines. The B-line cumulative distribution was symmetric at rest (right/left = 1.10) and asymmetric with left lung predominance during stress (right/left = 0.67). The correlation of per-patient B-line number between 28-S and 16-S (R 2 = 0.9478), 8-S (R 2 = 0.9478) and 4-S scan (R 2 = 0.9146) was excellent, but only good with 1-S (R 2 = 0.8101). The average imaging and online analysis time were 5 s per space. In conclusion, during ESE, the comet map of lung water accumulation follows a predictable spatial pattern with wet spots preferentially aligned with the third IS and along the AA and MA lines. The time-saving 4-region scan is especially convenient during stress, simply dismissing dry regions and focusing on wet regions alone.

Published
2017

3. Quality control of B-lines analysis in stress Echo 2020

Author

Scali, M. C., Ciampi, Q., Picano, E., Bossone, E., Ferrara, F., Citro, R., Colonna, P., Costantino, M. F., Cortigiani, L., Andrea, A. D., Severino, S., Dodi, C., Gaibazzi, N., Galderisi, M., Barbieri, A., Monte, I., Mori, F., Reisenhofer, B., Re, F., Rigo, F., Trambaiolo, P., Amor, M., Lowenstein, J., Merlo, P. M., Daros, C. B., De Castro E Silva Pretto, J. L., Miglioranza, M. H., Torres, M. A. R., De Azevedo Bellagamba, C. C., Chaves, D. Q., Simova, I., Varga, A., Celutkiene, J., Kasprzak, J. D., Wierzbowska-Drabik, K., Lipiec, P., Weiner-Mik, P., Szymczyk, E., Wdowiak-Okrojek, K., Djordjevic-Dikic, A., Dekleva, M., Stankovic, I., Neskovic, A. N., Zagatina, A., Di Salvo, G., Perez, J. E., Camarozano, A. C., Corciu, A. I., Boshchenko, A., Lattanzi, F., Cotrim, C., Fazendas, P., Haberka, M., Sobkowic, B., Kosmala, W., Witkowski, T., Gosciniak, P., Salustri, A., Rodriguez-Zanella, H., Leal, L. I. M., Nikolic, A., Gligorova, S., Urluescu, M. -L., Fiorino, M., Novo, G., Preradovic-Kovacevic, T., Ostojic, M., Beleslin, B., Villari, B., De Nes, M., Paterni, M., Carpeggiani, C., Andreassi, M. G., Scali, Maria Chiara, Ciampi, Quirino, Picano, Eugenio, Bossone, Eduardo, Ferrara, Francesco, Citro, Rodolfo, Colonna, Paolo, Costantino, Marco Fabio, Cortigiani, Lauro, Andrea, Antonello D'., Severino, Sergio, Dodi, Claudio, Gaibazzi, Nicola, Galderisi, Maurizio, Barbieri, Andrea, Monte, Ine, Mori, Fabio, Reisenhofer, Barbara, Re, Federica, Rigo, Fausto, Trambaiolo, Paolo, Amor, Miguel, Lowenstein, Jorge, Merlo, Pablo Martin, Daros, Clarissa Borguezan, De Castro E Silva Pretto, José Lui, Miglioranza, Marcelo Haertel, Torres, Marco A. R., De Azevedo Bellagamba, Clarissa Carmona, Chaves, Daniel Quesada, Simova, Iana, Varga, Albert, Čelutkiene, Jelena, Kasprzak, Jaroslaw D., Wierzbowska-Drabik, Karina, Lipiec, Piotr, Weiner-Mik, Paulina, Szymczyk, Eva, Wdowiak-Okrojek, Katarzyna, Djordjevic-Dikic, Ana, Dekleva, Milica, Stankovic, Ivan, Neskovic, Aleksandar N., Zagatina, Angela, Di Salvo, Giovanni, Perez, Julio E., Camarozano, Ana Cristina, Corciu, Anca Irina, Boshchenko, Alla, Lattanzi, Fabio, Cotrim, Carlo, Fazendas, Paula, Haberka, Maciej, Sobkowic, Bozena, Kosmala, Wojciech, Witkowski, Tomasz, Gosciniak, Piotr, Salustri, Alessandro, Rodriguez-Zanella, Hugo, Leal, Luis Ignacio Martin, Nikolic, Alexandra, Gligorova, Suzana, Urluescu, Madalina-Loredana, Fiorino, Maria, Novo, Giuseppina, Preradovic-Kovacevic, Tamara, Ostojic, Miodrag, Beleslin, Branko, Villari, Bruno, De Nes, Michele, Paterni, Marco, Carpeggiani, Clara, Andreassi, Maria Grazia, Scali, Mc, Ciampi, Q, Picano, E, Bossone, E, Ferrara, F, Citro, R, Colonna, P, Costantino, Mf, Cortigiani, L, D'Andrea, A, Severino, S, Dodi, C, Gaibazzi, N, Galderisi, M, Barbieri, A, Monte, I, Mori, F, Reisenhofer, B, Re, F, Rigo, F, Trambaiolo, P, Amor, M, Lowenstein, J, Merlo, Pm, Daros, Cb, Pretto, Jlde, Miglioranza, Mh, Torres, Mar, Bellagamba, Ccd, Chaves, Dq, Simova, I, Varga, A, Celutkiene, J, Kasprzak, Jd, Wierzbowska-Drabik, K, Lipiec, P, Weiner-Mik, P, Szymczyk, E, Wdowiak-Okrojek, K, Djordjevic-Dikic, A, Dekleva, M, Stankovic, I, Neskovic, An, Zagatina, A, Di Salvo, G, Perez, Je, Camarozano, Ac, Corciu, Ai, Boshchenko, A, Lattanzi, F, Cotrim, C, Fazendas, P, Haberka, M, Sobkowic, B, Kosmala, W, Witkowski, T, Gosciniak, P, Salustri, A, Rodriguez-Zanella, H, Leal, Lim, Nikolic, A, Gligorova, S, Urluescu, Ml, Fiorino, M, Novo, G, Preradovic-Kovacevic, T, Ostojic, M, Beleslin, B, Villari, B, De Nes, M, Paterni, M, and Carpeggiani, C

Subjects
Male, lcsh:Diseases of the circulatory (Cardiovascular) system, Diagnostic accuracy, 030204 cardiovascular system & hematology, 0302 clinical medicine, Nuclear Medicine and Imaging, Reading (process), Medicine, Lung, media_common, Controle de qualidade, certification, lung comets, quality control, stress echocardiography, wall motion, General Medicine, Middle Aged, Echocardiography, Female, Radiology, Cardiology and Cardiovascular Medicine, Human, Echocardiography, Stress, Quality Control, Certification, Lung comets, Quality control, Stress echocardiography, Wall motion, Humans, Internet, Pulmonary Edema, Radiology, Nuclear Medicine and Imaging, medicine.medical_specialty, Correlation coefficient, media_common.quotation_subject, Stress, Lung comet, Ecocardiografia sob estresse, 03 medical and health sciences, Echocardiography, Stre, Internal medicine, Radiology, Nuclear Medicine and imaging, Quality (business), Doenças cardiovasculares, business.industry, 030208 emergency & critical care medicine, Gold standard (test), Lung ultrasound, lcsh:RC666-701, Stress Echo, Nuclear medicine, business, Certificação
Abstract

Background The effectiveness trial “Stress echo (SE) 2020” evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. Purpose To provide web-based upstream quality control and harmonization of B-lines reading criteria. Methods 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 (≥ 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. Results All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 ± 3 vs 29 ± 12 min, p

Published
2018

4. The Functional Meaning of B-Profile During Stress Lung Ultrasound

Author

Angela Zagatina, Antonello D'Andrea, Milica Dekleva, Fabio Lattanzi, Paolo Colonna, Maurizio Galderisi, Ana Djordjevic-Dikic, Nadezhda Zhuravaskaya, Federica Re, Alla A. Boshchenko, Quirino Ciampi, Ines Monte, Katia Coviello, Maria Chiara Scali, Pablo Merlo, Eugenio Picano, Albert Varga, Rodolfo Citro, Clara Carpeggiani, Iana Simova, Claudio Dodi, Lauro Cortigiani, Fausto Rigo, José Luis de Castro e Silva Pretto, Jarosław D. Kasprzak, Karina Wierzbowska-Drabik, Scali, Maria Chiara, Zagatina, Angela, Ciampi, Quirino, Cortigiani, Lauro, D'Andrea, Antonello, Djordjevic-Dikic, Ana, Merlo, Pablo Martin, Lattanzi, Fabio, Simova, Iana, Monte, Ine, Dodi, Claudio, Kasprzak, Jaroslaw D, Galderisi, Maurizio, Boshchenko, Alla, Rigo, Fausto, Varga, Albert, Dekleva, Milica, Re, Federica, de Castro E Silva Pretto, José Lui, Zhuravaskaya, Nadezhda, Wierzbowska-Drabik, Karina, Coviello, Katia, Citro, Rodolfo, Colonna, Paolo, Carpeggiani, Clara, and Picano, Eugenio

Subjects
Male, medicine.medical_specialty, Vasodilator Agents, Myocardial Ischemia, Pulmonary Edema, 030204 cardiovascular system & hematology, stress echo, 030218 nuclear medicine & medical imaging, Coronary artery disease, B-lines, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, Medicine, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Prospective cohort study, Lung, Aged, business.industry, Ultrasound, Middle Aged, medicine.disease, Lung ultrasound, Normal lung, Heart failure, Cardiology, Exercise Test, Female, Pulmonary congestion, Exercise stress echocardiography, B-lines, stress echo, Cardiology and Cardiovascular Medicine, business, Echocardiography, Stress
Abstract

The B-Profile of normal lung sliding with B-lines by lung ultrasound (LUS) identifies pulmonary congestion at rest and during exercise stress echocardiography (SE) in coronary artery disease (CAD) [(1)][1] or heart failure (HF) patients with either reduced [(2)][2] or preserved [(3)][3] resting

Published
2018

5. Quality control of regional wall motion analysis in stress Echo 2020

Author

Ivan Stankovic, Bruno Villari, Jorge Lowenstein, Antonello D'Andrea, Angela Zagatina, Marco Fabio Costantino, Sergio Severino, Fausto Rigo, Maria Chiara Scali, Ayana Arystan, Marco Paterni, Clara Carpeggiani, Iana Simova, Jelena Celutkiene, Maurizio Galderisi, Albert Varga, Rodolfo Citro, Marco Antonio Rodrigues Torres, Lauro Cortigiani, Nicola Gaibazzi, Paolo Colonna, Jarosław D. Kasprzak, Eugenio Picano, Ana Djordjevic-Dikic, Giovanni Di Salvo, Daniel Quesada Chaves, Ines Monte, Quirino Ciampi, Pablo Merlo, Fabio Mori, Clarissa Borguezan Daros, Federica Re, Paolo Trambaiolo, Julio E. Pérez, Claudio Dodi, Michele De Nes, Milica Dekleva, Aleksander Neskovic, Laura Massa, Miguel Amor, José Luis de Castro e Silva Pretto, Ciampi, Quirino, Picano, Eugenio, Paterni, Marco, Daros, Clarissa Borguezan, Simova, Iana, Josã© Luis, De Castro E. Silva Pretto, Scali, Maria Chiara, Gaibazzi, Nicola, Severino, Sergio, Djordjevic dikic, Ana, Kasprzak, Jaroslaw D., Zagatina, Angela, Varga, Albert, Lowenstein, Jorge, Merlo, Pablo Martin, Amor, Miguel, Celutkiene, Jelena, Perez, Julio E., DI SALVO, Giovanni, Galderisi, Maurizio, Mori, Fabio, Costantino, Marco Fabio, Massa, Laura, Dekleva, Milica, Chaves, Daniel Quesada, Trambaiolo, Paolo, Citro, Rodolfo, Colonna, Paolo, Rigo, Fausto, Torres, Marco A. R., Monte, Ine, Stankovic, Ivan, Neskovic, Aleksander, Cortigiani, Lauro, Re, Federica, Dodi, Claudio, D'Andrea, Antonello, Villari, Bruno, Arystan, Ayana, De Nes, Michele, Carpeggiani, Clara, de Castro e Silva Pretto, José Lui, Djordjevic-Dikic, Ana, and Di Salvo, Giovanni

Subjects
Quality Control, medicine.medical_specialty, Certification, Internationality, media_common.quotation_subject, Control (management), Coronary Disease, Quality control, Stress echocardiography, Wall motion, Cardiologists, Clinical Competence, Echocardiography, Stress, Humans, Reproducibility of Results, Audit, 030204 cardiovascular system & hematology, Stress, Credentialing, Session (web analytics), 03 medical and health sciences, 0302 clinical medicine, Reading (process), medicine, Quality (business), Medical physics, 030212 general & internal medicine, Set (psychology), media_common, business.industry, Cardiology and Cardiovascular Medicine, Gold standard, Echocardiography, Radiology, business
Abstract

Background: The trial "Stress Echo (SE) 2020" evaluates novel applications of SE beyond coronary artery disease. The aim of the study was control quality and harmonize reading criteria.Methods: One reader from 78 centers of the SE 2020 network asked for credentials to read a set of 20 SE videoclips selected by the core lab. All aspiring centers met the pre-requisite of high-volume and the years of experience in SE ranged from 5 to 31 years (mean value 18 years). The diagnostic gold standard was a reading by the core lab. The a priori determined pass threshold was 18/20 (>= 90%).Results: Of the initial 78 who started, 57 completed the first attempt: individual readers' score on first attempt ranged from 07/20 to 20/20 (accuracy from 35% to 100%, mean 78.7 +/- 13%) and 44 readers passed it. There was a very poor correlation between years of experience and the reader's score on first attempt (r = -0.161, p = 0.231). Of the 13 readers who failed the first attempt, 12 took it again after the web-based session and their accuracy improved (74% vs. 96%, p < 0.001). The kappa inter-observer agreement before and after web-based training was 0.59 on first attempt and rose to 0.91 on the last attempt.Conclusions: In SE reading, the volume of activity or years of experience is not synonymous with diagnostic quality. Qualitative analysis and operator-dependence can become a limiting weakness in clinical practice, in the absence of strict pathways of learning, credentialing and audit. (C) 2017 Elsevier B.V. All rights reserved.

Published
2017

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