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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
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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
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3. Variable association of 24-h peripheral and central hemodynamics and stiffness with hypertension-mediated organ damage: the VASOTENS Registry

Author

Elena A Grigoricheva, Irina E. Minyukhina, Ioan Tilea, João Maldonado, Giuseppe Mulè, Telmo Pereira, Vitaliy S. Barkan, Gabriel Waisman, Natalia Bulanova, Gianfranco Parati, Iana Orlova, Anna Paini, Carlos G Ramos-Becerra, Stefano Omboni, M. Derevyanchenko, Isabella Tan, Ayana Arystan, Igor N Posokhov, Omboni, Stefano, Posokhov, Igor, Parati, Gianfranco, Arystan, Ayana, Tan, Isabella, Barkan, Vitaliy, Bulanova, Natalia, Derevyanchenko, Maria, Grigoricheva, Elena, Minyukhina, Irina, Mulè, Giuseppe, Orlova, Iana, Paini, Anna, Peixoto Maldonado, João M, Pereira, Telmo, Ramos-Becerra, Carlos G, Tilea, Ioan, and Waisman, Gabriel

Subjects
Adult, Male, medicine.medical_specialty, Settore MED/09 - Medicina Interna, Physiology, arterial stiffness, augmentation index, blood pressure, blood pressure telemonitoring, central arterial pressure, hypertension, pulse wave velocity, vascular biomarkers, Renal function, Hemodynamics, Blood Pressure, 030204 cardiovascular system & hematology, Pulse Wave Analysis, Kidney, Carotid Intima-Media Thickness, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Internal Medicine, medicine, Humans, 030212 general & internal medicine, Registries, Pulse wave velocity, Aged, Settore MED/14 - Nefrologia, business.industry, Blood Pressure Determination, Odds ratio, Blood Pressure Monitoring, Ambulatory, Middle Aged, medicine.disease, Pulse pressure, Blood pressure, Ambulatory, Hypertension, Cardiology, Arterial stiffness, Female, Cardiology and Cardiovascular Medicine, business, Glomerular Filtration Rate
Abstract

Objective In this analysis of the telehealth-based Vascular health ASsessment Of The hypertENSive patients Registry, we checked how 24-h central and peripheral hemodynamics compare with hypertension-mediated organ damage (HMOD). Methods In 646 hypertensive patients (mean age 52 ± 16 years, 54% males, 65% treated) we obtained ambulatory brachial and central SBP and pulse pressure (PP), SBP, and PP variability, pulse wave velocity and augmentation index with a validated cuff-based technology. HMOD was defined by an increased left ventricular mass index (cardiac damage, evaluated in 482 patients), an increased intima-media thickness (vascular damage, n = 368), or a decreased estimated glomerular filtration rate or increased urine albumin excretion (renal damage, n = 388). Results Ambulatory SBP and PPs were significantly associated with cardiac damage: the largest odds ratio was observed for 24-h central SBP [1.032 (1.012, 1.051), P = 0.001] and PP [1.042 (1.015, 1.069), P = 0.002], the weakest for brachial estimates. The association was less strong for vascular damage with a trend to the superiority of 24-h central [1.036 (0.997, 1.076), P = 0.070] over brachial PP [1.031 (1.000, 1.062), P = 0.052]. No statistically significant association was observed for renal damage. SBP and PP variabilities, pulse wave velocity and augmentation index were not associated with any form of HMOD. In the multivariate analysis, age was associated with any type of HMOD, whereas central SBP and PP were predictive of an increased risk of cardiac damage. Conclusion In hypertensive patients a variable association exists between peripheral and central hemodynamics and various types of HMOD, with the most predictive power being observed for central SBP and PP for cardiac damage.

Published
2019

4. 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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