15 results on '"Clarissa Borguezan Daros"'
Search Results
2. Quality control of B-lines analysis in stress Echo 2020
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Maria Chiara Scali, Quirino Ciampi, Eugenio Picano, Eduardo Bossone, Francesco Ferrara, Rodolfo Citro, Paolo Colonna, Marco Fabio Costantino, Lauro Cortigiani, Antonello D’. Andrea, Sergio Severino, Claudio Dodi, Nicola Gaibazzi, Maurizio Galderisi, Andrea Barbieri, Ines Monte, Fabio Mori, Barbara Reisenhofer, Federica Re, Fausto Rigo, Paolo Trambaiolo, Miguel Amor, Jorge Lowenstein, Pablo Martin Merlo, Clarissa Borguezan Daros, José Luis de Castro e Silva Pretto, Marcelo Haertel Miglioranza, Marco A. R. Torres, Clarissa Carmona de Azevedo Bellagamba, Daniel Quesada Chaves, Iana Simova, Albert Varga, Jelena Čelutkienė, Jaroslaw D. Kasprzak, Karina Wierzbowska-Drabik, Piotr Lipiec, Paulina Weiner-Mik, Eva Szymczyk, Katarzyna Wdowiak-Okrojek, Ana Djordjevic-Dikic, Milica Dekleva, Ivan Stankovic, Aleksandar N. Neskovic, Angela Zagatina, Giovanni Di Salvo, Julio E. Perez, Ana Cristina Camarozano, Anca Irina Corciu, Alla Boshchenko, Fabio Lattanzi, Carlos Cotrim, Paula Fazendas, Maciej Haberka, Bozena Sobkowic, Wojciech Kosmala, Tomasz Witkowski, Piotr Gosciniak, Alessandro Salustri, Hugo Rodriguez-Zanella, Luis Ignacio Martin Leal, Alexandra Nikolic, Suzana Gligorova, Madalina-Loredana Urluescu, Maria Fiorino, Giuseppina Novo, Tamara Preradovic-Kovacevic, Miodrag Ostojic, Branko Beleslin, Bruno Villari, Michele De Nes, Marco Paterni, Clara Carpeggiani, and on behalf of Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI)
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Certification ,Lung comets ,Quality control ,Stress echocardiography ,Wall motion ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
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
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- 2018
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3. Pulmonary Congestion During Exercise Stress Echocardiography in Ischemic and Heart Failure Patients
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Elisa, Merli, Quirino, Ciampi, Maria Chiara, Scali, Angela, Zagatina, Pablo Martin, Merlo, Rosina, Arbucci, Clarissa Borguezan, Daros, José Luis, de Castro E Silva Pretto, Miguel, Amor, Michael F, Salamè, Hugo, Mosto, Doralisa, Morrone, Antonello, D'Andrea, Barbara, Reisenhofer, Hugo, Rodriguez-Zanella, Karina, Wierzbowska-Drabik, Jaroslaw D, Kasprzak, Gergely, Agoston, Albert, Varga, Jorge, Lowenstein, Claudio, Dodi, Lauro, Cortigiani, Iana, Simova, Martina, Samardjieva, Rodolfo, Citro, Jelena, Celutkiene, Federica, Re, Ines, Monte, Suzana, Gligorova, Francesco, Antonini-Canterin, Mauro, Pepi, Clara, Carpeggiani, Patricia A, Pellikka, and Eugenio, Picano
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coronary artery disease ,echocardiography ,heart failure ,hypertension ,lung ,stress echocardiography ,Heart Failure ,Humans ,Radiology, Nuclear Medicine and imaging ,Stroke Volume ,Cardiology and Cardiovascular Medicine ,Prognosis ,Lung ,Echocardiography, Stress - Abstract
Background: Lung ultrasound detects pulmonary congestion as B-lines at rest, and more frequently, during exercise stress echocardiography (ESE). Methods: We performed ESE plus lung ultrasound (4-site simplified scan) in 4392 subjects referred for semi-supine bike ESE in 24 certified centers in 9 countries. B-line score ranged from 0 (normal) to 40 (severely abnormal). Five different populations were evaluated: control subjects (n=103); chronic coronary syndromes (n=3701); heart failure with reduced ejection fraction (n=395); heart failure with preserved ejection fraction (n=70); ischemic mitral regurgitation ≥ moderate at rest (n=123). In a subset of 2478 patients, follow-up information was available. Results: During ESE, B-lines increased in all study groups except controls. Age, hypertension, abnormal ejection fraction, peak wall motion score index, and abnormal heart rate reserve were associated with B-lines in multivariable regression analysis. Stress B lines (hazard ratio, 2.179 [95% CI, 1.015–4.680]; P =0.046) and ejection fraction P =0.012) were independent predictors of all-cause death (n=29 after a median follow-up of 29 months). Conclusions: B-lines identify the pulmonary congestion phenotype at rest, and more frequently, during ESE in ischemic and heart failure patients. Stress B-lines may help to refine risk stratification in these patients. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT 03049995.
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- 2022
4. Functional, Anatomical, and Prognostic Correlates of Coronary Flow Velocity Reserve During Stress Echocardiography
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Fausto Rigo, Iana Simova, Antonello D'Andrea, Pablo Merlo, Clarissa Borguezan Daros, Eugenio Picano, Alla A. Boshchenko, Eduardo Bossone, Suzana Gligorova, Fabio Marco Costantino, Nadezhda Zhuravskaya, Ana Djordjevic-Dikic, Albert Varga, Michele De Nes, Rodolfo Citro, Marco Antonio Rodrigues Torres, Marco Paterni, Dario Gregori, Milica Dekleva, Maria Chiara Scali, Angela Zagatina, Sergio Severino, Alessandro Salustri, Clara Carpeggiani, Lauro Cortigiani, Alexander V. Vrublevsky, Fabio Lattanzi, Paolo Colonna, Ines Monte, Quirino Ciampi, Hugo Rodríguez-Zanella, Jorge Lowenstein, Jarosław D. Kasprzak, Nicola Gaibazzi, Claudio Dodi, José Luis de Castro e Silva Pretto, Karina Wierzbowska-Drabik, Miguel Amor, Ciampi, Q., Zagatina, A., Cortigiani, L., Gaibazzi, N., Borguezan Daros, C., Zhuravskaya, N., Wierzbowska-Drabik, K., Kasprzak, J. D., de Castro e Silva Pretto, J. L., D'Andrea, A., Djordjevic-Dikic, A., Monte, I., Simova, I., Boshchenko, A., Citro, R., Amor, M., Merlo, P. M., Dodi, C., Rigo, F., Gligorova, S., Dekleva, M., Severino, S., Lattanzi, F., Scali, M. C., Vrublevsky, A., Torres, M. A. R., Salustri, A., Rodriguez-Zanella, H., Costantino, F. M., Varga, A., Bossone, E., Colonna, P., De Nes, M., Paterni, M., Carpeggiani, C., Lowenstein, J., Gregori, D., and Picano, E.
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Male ,coronary artery disease ,coronary flow velocity reserve ,heart failure ,lung ultrasound ,stress echocardiography ,medicine.medical_specialty ,Diastole ,030204 cardiovascular system & hematology ,Anterior Descending Coronary Artery ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Stress Echocardiography ,Humans ,Prospective Studies ,030212 general & internal medicine ,Aged ,Ejection fraction ,business.industry ,Odds ratio ,Middle Aged ,Prognosis ,medicine.disease ,3. Good health ,Fractional Flow Reserve, Myocardial ,Heart failure ,Cardiology ,Female ,Dobutamine ,Cardiology and Cardiovascular Medicine ,business ,Blood Flow Velocity ,Echocardiography, Stress ,medicine.drug - Abstract
Background: The assessment of coronary flow velocity reserve (CFVR) in left anterior descending coronary artery (LAD) expands the risk stratification potential of stress echocardiography (SE) based on stress-induced regional wall motion abnormalities (RWMA). Objectives: The purpose of this study was to assess the feasibility and functional correlates of CFVR. Methods: This prospective, observational, multicenter study initially screened 3,410 patients (2,061 [60%] male; age 63 ± 11 years; ejection fraction 61 ± 9%) with known or suspected coronary artery disease and/or heart failure. All patients underwent SE (exercise, n = 1,288; vasodilator, n = 1,860; dobutamine, n = 262) based on new or worsening RWMA in 20 accredited laboratories of 8 countries. CFVR was calculated as the stress/rest ratio of diastolic peak flow velocity pulsed-Doppler assessment of LAD flow. A subset of 1,867 patients was followed up. Results: The success rate for CFVR on LAD was 3,002 of 3,410 (feasibility = 88%). Reduced (≤2.0) CFVR was found in 896 of 3,002 (30%) patients. At multivariable logistic regression analysis, inducible RWMA (odds ratio [OR]: 6.5; 95% confidence interval [CI]: 4.9 to 8.5; p < 0.01), abnormal left ventricular contractile reserve (OR: 3.4; 95% CI: 2.7 to 4.2; p < 0.01), and B-lines (OR: 1.5; 95% CI: 1.1 to 1.9; p = 0.01) were associated with reduced CFVR. During a median follow-up time of 16 months, 218 events occurred. RWMA (hazard ratio: 3.8; 95% CI: 2.3 to 6.3; p < 0.001) and reduced CFVR (hazard ratio: 1.5; 95% CI: 1.1 to 2.2; p = 0.009) were independently associated with adverse outcome. Conclusions: CFVR is feasible with all SE protocols. Reduced CFVR is often accompanied by RWMA, abnormal LVCR, and pulmonary congestion during stress, and shows independent value over RWMA in predicting an adverse outcome.
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- 2019
5. Left ventricular contractile reserve, coronary flow reserve, and heart rate reserve during dipyridamole stress echocardiography predict survival in non-ischemic heart failure
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Francesco Antonini-Canterin, Clara Carpeggiani, Nicola Gaibazzi, Eugenio Picano, Lauro Cortigiani, Fausto Rigo, Clarissa Borguezan Daros, Valentina Lorenzoni, Bruno Villari, M De Nes, and Quirino Ciampi
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medicine.medical_specialty ,business.industry ,Coronary flow reserve ,medicine.disease ,Dipyridamole ,Heart failure ,Internal medicine ,medicine ,Stress Echocardiography ,Cardiology ,Non ischemic ,Cardiology and Cardiovascular Medicine ,business ,Heart rate reserve ,medicine.drug - Abstract
Background Left ventricular contractile reserve (LVCR), coronary flow velocity reserve (CFVR), and heart rate reserve (HRR) have recognized independent impact on outcome in heart failure (HF). They all can be simultaneously measured during dipyridamole stress echocardiography (DSE). Aim To assess the value of comprehensive DSE in patients with non-ischemic heart failure. Methods We evaluated 613 patients with HF, no history of coronary artery disease and no inducible regional wall motion abnormalities: 270 patients with preserved (≥50%) ejection fraction; 147 with mid-range (40–49%) ejection fraction; 196 with HF and reduced ( Results Abnormal CFVR, LVCR and HRR occurred in 29%, 44% and 46% of patients, respectively. After a median follow-up time of 20 months (interquartile range 12–32 months), 41 patients died. Annual mortality rate was lowest in patients (n=200) with normal response, and >10-fold higher in patients (n=96) with 3 abnormal criteria: see figure. At multivariable analysis, a reduced HRR (Hazard Ratio = 3.402, 95% Confidence Intervals 1.530–7.565, p=0.003) was the strongest SE independent predictor of all-cause death. Conclusion Abnormal LVCR, CFVR and HRR can be frequently observed during vasodilator SE in HF patients. They target different pathophysiological vulnerabilities (myocardial function, coronary microcirculation and cardiac autonomic system) and are useful for outcome prediction. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Consiglio nazionale delle ricerche - Institute of Clinical Physiology Figure 1
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- 2021
6. Hemodynamic Heterogeneity of Reduced Cardiac Reserve Unmasked by Volumetric Exercise Echocardiography
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Tonino Bombardini, Angela Zagatina, Quirino Ciampi, Rosina Arbucci, Pablo Martin Merlo, Diego M. Lowenstein Haber, Doralisa Morrone, Antonello D'Andrea, Ana Djordjevic-Dikic, Branko Beleslin, Milorad Tesic, Nikola Boskovic, Vojislav Giga, José Luis de Castro e Silva Pretto, Clarissa Borguezan Daros, Miguel Amor, Hugo Mosto, Michael Salamè, Ines Monte, Rodolfo Citro, Iana Simova, Martina Samardjieva, Karina Wierzbowska-Drabik, Jaroslaw D. Kasprzak, Nicola Gaibazzi, Lauro Cortigiani, Maria Chiara Scali, Mauro Pepi, Francesco Antonini-Canterin, Marco A. R. Torres, Michele De Nes, Miodrag Ostojic, Clara Carpeggiani, Tamara Kovačević-Preradović, Jorge Lowenstein, Adelaide M. Arruda-Olson, Patricia A. Pellikka, Eugenio Picano, and on behalf of the Stress Echo 2020 Study Group of the Italian Society of Cardiovascular Imaging
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medicine.medical_specialty ,stress echocardiography ,Cardiac index ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Stress Echocardiography ,heart rate ,Medicine ,030212 general & internal medicine ,cardiac reserve ,End-systolic volume ,Ejection fraction ,end-systolic volume ,Cardiac reserve ,End-diastolic volume ,Heart rate ,Stress echocardiography ,business.industry ,General Medicine ,Stroke volume ,Preload ,Cardiology ,business ,end-diastolic volume - Abstract
Background: Two-dimensional volumetric exercise stress echocardiography (ESE) provides an integrated view of left ventricular (LV) preload reserve through end-diastolic volume (EDV) and LV contractile reserve (LVCR) through end-systolic volume (ESV) changes. Purpose: To assess the dependence of cardiac reserve upon LVCR, EDV, and heart rate (HR) during ESE. Methods: We prospectively performed semi-supine bicycle or treadmill ESE in 1344 patients (age 59.8 ± 11.4 years, ejection fraction = 63 ± 8%) referred for known or suspected coronary artery disease. All patients had negative ESE by wall motion criteria. EDV and ESV were measured by biplane Simpson rule with 2-dimensional echocardiography. Cardiac index reserve was identified by peak-rest value. LVCR was the stress-rest ratio of force (systolic blood pressure by cuff sphygmomanometer/ESV, abnormal values ≤2.0). Preload reserve was defined by an increase in EDV. Cardiac index was calculated as stroke volume index * HR (by EKG). HR reserve (stress/rest ratio) <, 1.85 identified chronotropic incompetence. Results: Of the 1344 patients, 448 were in the lowest tertile of cardiac index reserve with stress. Of them, 303 (67.6%) achieved HR reserve <, 1.85, 252 (56.3%) had an abnormal LVCR and 341 (76.1%) a reduction of preload reserve, with 446 patients (99.6%) showing ≥1 abnormality. At binary logistic regression analysis, reduced preload reserve (odds ratio [OR]: 5.610, 95% confidence intervals [CI]: 4.025 to 7.821), chronotropic incompetence (OR: 3.923, 95% CI: 2.915 to 5.279), and abnormal LVCR (OR: 1.579, 95% CI: 1.105 to 2.259) were independently associated with lowest tertile of cardiac index reserve at peak stress. Conclusions: Heart rate assessment and volumetric echocardiography during ESE identify the heterogeneity of hemodynamic phenotypes of impaired chronotropic, preload or LVCR underlying a reduced cardiac reserve.
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- 2021
7. Sustainability and Versatility of the ABCDE Protocol for Stress Echocardiography
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Angela Zagatina, Clarissa Borguezan Daros, Karina Wierzbowska-Drabik, Eugenio Picano, Antonello D'Andrea, and Quirino Ciampi
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medicine.medical_specialty ,lcsh:Medicine ,heart failure ,CAD ,Disease ,Review ,030204 cardiovascular system & hematology ,functional test ,stress echo ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Epidemiology ,Heart rate ,Stress Echocardiography ,medicine ,030212 general & internal medicine ,business.industry ,lcsh:R ,General Medicine ,medicine.disease ,sustainability ,Preload ,Heart failure ,Cardiology ,business ,coronary artery disease - Abstract
For the past 40 years, the methodology for stress echocardiography (SE) has remained basically unchanged. It is based on two-dimensional, black and white imaging, and is used to detect regional wall motion abnormalities (RWMA) in patients with known or suspected coronary artery disease (CAD). In the last five years much has changed and RWMA is not enough on its own to stratify patient risk and dictate therapy. Patients arriving at SE labs often have comorbidities and are undergoing full anti-ischemic therapy. The SE positivity rate based on RWMA fell from 70% in the eighties to 10% in the last decade. The understanding of CAD pathophysiology has shifted from a regional hydraulic disease to a systemic biologic disease. The conventional view of CAD encouraged the use of coronary anatomic imaging for diagnosis and the oculo-stenotic reflex for the deployment of therapy. This has led to a clinical oversimplification that ignores the lessons of pathophysiology and epidemiology, and in fact, CAD is not synonymous with ischemic heart disease. Patients with CAD may also have other vulnerabilities such as coronary plaque (step A of ABCDE-SE), alveolar-capillary membrane and pulmonary congestion (step B), preload and contractile reserve (step C), coronary microcirculation (step D) and cardiac autonomic balance (step E). The SE methodology based on two-dimensional echocardiography is now integrated with lung ultrasound (step B for B-lines), volumetric echocardiography (step C), color- and pulsed-wave Doppler (step D) and non-imaging electrocardiogram-based heart rate assessment (step E). In addition, qualitative assessment based on the naked eye has now become more quantitative, has been improved by contrast and based on cardiac strain and artificial intelligence. ABCDE-SE is now ready for large scale multicenter testing in the SE2030 study.
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- 2020
8. Feasibility and value of two-dimensional volumetric stress echocardiography
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T. Bombardini, Katarzyna Wdowiak-Okrojek, Ana Djordjevic-Dikic, R Arbucci, Fabio Lattanzi, Nicola Gaibazzi, Granit Rabia, Eduardo Bossone, Ewa Szymczyk, Doralisa Morrone, Michael Salamé, Alla A. Boshchenko, Alessandro Salustri, Francesco Ferrara, Giovanni Di Salvo, Aleksandra Nikolic, Marco A Torres, Paulina Wejner-Mik, Milorad Tesic, Angela Zagatina, Branko Beleslin, Suzana Gligorova, Tamara Ryabova, Jarosław D. Kasprzak, Fausto Rigo, Claudio Dodi, Antonello D'Andrea, Barbara Reisenhofer, José Luis de Castro e Silva Pretto, Clarissa Borguezan Daros, Nikola Boskovic, Eugenio Picano, Jelena Celutkiene, Clara Carpeggiani, Sergio Severino, Lauro Cortigiani, Andrea Barbieri, Nadezhda Zhuravskaya, Maria Chiara Scali, Fabio Marco Costantino, Marija Petrović, Jorge Lowenstein, Michele De Nes, Federica Re, Ana Cristina Camarozano, Karina Wierzbowska-Drabik, Gergely Ágoston, Milica Dekleva, Maciej Haberka, Iana Simova, Paul E Vargas Mieles, Pablo Merlo, Miguel Amor, Albert Varga, Fabio Mori, Miodrag Ostojic, Paolo Colonna, Rodolfo Citro, Hugo Rodríguez-Zanella, Ines Monte, Martina Vladova, Quirino Ciampi, Marco Paterni, Tamara Kovacevic Preradovic, Maria Grazia D'Alfonso, and Dario Gregori
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Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Dobutamine ,Internal medicine ,medicine ,Stress Echocardiography ,Humans ,030212 general & internal medicine ,Aged ,Heart Failure ,business.industry ,Stroke volume ,Middle Aged ,medicine.disease ,3. Good health ,Dipyridamole ,Preload ,Blood pressure ,Echocardiography ,Heart failure ,Cardiology ,Feasibility Studies ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Stress ,medicine.drug - Abstract
Background Stroke volume response during stress is a major determinant of functional status in heart failure and can be measured by two-dimensional (2-D) volumetric stress echocardiography (SE). The present study hypothesis is that SE may identify mechanisms underlying the change in stroke volume by measuring preload reserve through end-diastolic volume (EDV) and left ventricular contractile reserve (LVCR) with systolic blood pressure and end-systolic volume (ESV). Methods We enrolled 4,735 patients (age 63.6 ± 11.3 yrs, 2800 male) referred to SE for known or suspected coronary artery disease (CAD) and/or heart failure (HF) in 21 SE laboratories in 8 countries. In addition to regional wall motion abnormalities (RWMA), force was measured at rest and peak stress as the ratio of systolic blood pressure by cuff sphygmomanometer/ESV by 2D with Simpson's or linear method. Abnormal values of LVCR (peak/rest) based on force were ≤1.10 for dipyridamole (n=1,992 patients) and adenosine (n=18); ≤2.0 for exercise (n=2,087) or dobutamine (n=638). Results Force-based LVCR was obtained in all 4,735 pts. Lack of stroke volume increase during stress was due to either abnormal LVCR and/or blunted preload reserve, and 57 % of patients with abnormal LVCR nevertheless showed increase in stroke volume. Conclusions Volumetric SE is highly feasible with all stresses, and more frequently impaired in presence of ischemic RWMA, absence of viability and reduced coronary flow velocity reserve. It identifies an altered stroke volume response due to reduced preload and/or contractile reserve.
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- 2020
9. Lung Ultrasound and Pulmonary Congestion During Stress Echocardiography
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Fausto Rigo, Katarzyna Wdowiak-Okrojek, Fabio Lattanzi, Ana Djordjevic-Dikic, Karina Wierzbowska-Drabik, Eugenio Picano, Francesco Ferrara, Paul E Vargas Mieles, Doralisa Morrone, Angela Zagatina, Claudio Dodi, Barbara Reisenhofer, Tamara Preradovic-Kovacevic, Jarosław D. Kasprzak, Hugo Rodríguez-Zanella, Miguel Amor, Aleksandra Nikolic, Alessandro Salustri, Clarissa Borguezan Daros, Nicola Gaibazzi, Maciej Haberka, Federica Re, Iana Simova, Nikola Boskovic, Gergely Ágoston, Eduardo Bossone, Marco Paterni, Antonello D'Andrea, Clara Carpeggiani, Michele De Nes, Quirino Ciampi, Ewa Szymczyk, Sergio Severino, Maria Chiara Scali, Fabio Mori, Diego M. Lowenstein Haber, Miodrag Ostojic, Lauro Cortigiani, Milica Dekleva, Ana Cristina Camarozano, Giovanni Di Salvo, Maria Grazia D'Alfonso, Maurizio Galderisi, Alla A. Boshchenko, José Luis de Castro e Silva Pretto, Milorad Tesic, Branko Beleslin, Elisa Merli, Alexander V. Vrublevsky, Paulina Wejner-Mik, T. Bombardini, Paolo Colonna, Jelena Celutkiene, Fabio Marco Costantino, Ines Monte, Valentina Lorenzoni, Jorge Lowenstein, Pablo Merlo, Martina Vladova, Suzana Gligorova, Andrea Barbieri, Nadezhda Zhuravskaya, Albert Varga, R Arbucci, Rodolfo Citro, Marco Antonio Rodrigues Torres, Marcelo Haertel Miglioranza, Marija Petrović, Scali, M. C., Zagatina, A., Ciampi, Q., Cortigiani, L., D'Andrea, A., Daros, C. B., Zhuravskaya, N., Kasprzak, J. D., Wierzbowska-Drabik, K., Luis de Castro e Silva Pretto, J., Djordjevic-Dikic, A., Beleslin, B., Petrovic, M., Boskovic, N., Tesic, M., Monte, I., Simova, I., Vladova, M., Boshchenko, A., Vrublevsky, A., Citro, R., Amor, M., Vargas Mieles, P. E., Arbucci, R., Merlo, P. M., Lowenstein Haber, D. M., Dodi, C., Rigo, F., Gligorova, S., Dekleva, M., Severino, S., Lattanzi, F., Morrone, D., Galderisi, M., Torres, M. A. R., Salustri, A., Rodriguez-Zanella, H., Costantino, F. M., Varga, A., Agoston, G., Bossone, E., Ferrara, F., Gaibazzi, N., Celutkiene, J., Haberka, M., Mori, F., D'Alfonso, M. G., Reisenhofer, B., Camarozano, A. C., Miglioranza, M. H., Szymczyk, E., Wejner-Mik, P., Wdowiak-Okrojek, K., Preradovic-Kovacevic, T., Bombardini, T., Ostojic, M., Nikolic, A., Re, F., Barbieri, A., Di Salvo, G., Merli, E., Colonna, P., Lorenzoni, V., De Nes, M., Paterni, M., Carpeggiani, C., Lowenstein, J., and Picano, E.
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medicine.medical_specialty ,stress echocardiography ,heart failure ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Predictive Value of Tests ,Internal medicine ,Dobutamine ,Heart rate ,medicine ,Stress Echocardiography ,Humans ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,Lung ,lung ultrasound ,business.industry ,Hazard ratio ,medicine.disease ,Prognosis ,coronary artery disease ,Coronary Vessels ,3. Good health ,Heart failure ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Echocardiography, Stress - Abstract
Objectives The purpose of this study was to assess the functional and prognostic correlates of B-lines during stress echocardiography (SE). Background B-profile detected by lung ultrasound (LUS) is a sign of pulmonary congestion during SE. Methods The authors prospectively performed transthoracic echocardiography (TTE) and LUS in 2,145 patients referred for exercise (n = 1,012), vasodilator (n = 1,054), or dobutamine (n = 79) SE in 11 certified centers. B-lines were evaluated in a 4-site simplified scan (each site scored from 0: A-lines to 10: white lung for coalescing B-lines). During stress the following were also analyzed: stress-induced new regional wall motion abnormalities in 2 contiguous segments; reduced left ventricular contractile reserve (peak/rest based on force, ≤2.0 for exercise and dobutamine, ≤1.1 for vasodilators); and abnormal coronary flow velocity reserve ≤2.0, assessed by pulsed-wave Doppler sampling in left anterior descending coronary artery and abnormal heart rate reserve (peak/rest heart rate) ≤1.80 for exercise and dobutamine (≤1.22 for vasodilators). All patients completed follow-up. Results According to B-lines at peak stress patients were divided into 4 different groups: group I, absence of stress B-lines (score: 0 to 1; n = 1,389; 64.7%); group II, mild B-lines (score: 2 to 4; n = 428; 20%); group III, moderate B-lines (score: 5 to 9; n = 209; 9.7%) and group IV, severe B-lines (score: ≥10; n = 119; 5.4%). During median follow-up of 15.2 months (interquartile range: 12 to 20 months) there were 38 deaths and 28 nonfatal myocardial infarctions in 64 patients. At multivariable analysis, severe stress B-lines (hazard ratio [HR]: 3.544; 95% confidence interval [CI]: 1.466 to 8.687; p = 0.006), abnormal heart rate reserve (HR: 2.276; 95% CI: 1.215 to 4.262; p = 0.010), abnormal coronary flow velocity reserve (HR: 2.178; 95% CI: 1.059 to 4.479; p = 0.034), and age (HR: 1.031; 95% CI: 1.002 to 1.062; p = 0.037) were independent predictors of death and nonfatal myocardial infarction. Conclusions Severe stress B-lines predict death and nonfatal myocardial infarction. (Stress Echo 2020 - The International Stress Echo Study [SE2020]; NCT03049995)
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- 2020
10. Feasibility and functional correlates of left atrial volume changes during stress echocardiography in chronic coronary syndromes
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Ana Djordjevic-Dikic, Maria Grazia D'Alfonso, Karina Wierzbowska-Drabik, Jarosław D. Kasprzak, Clarissa Borguezan Daros, Clara Carpeggiani, Tamara Ryabova, Elisa Merli, Michele De Nes, Nikola Boskovic, Jorge Lowenstein, Miguel Amor, Jesús Peteiro, Pablo Merlo, Angela Zagatina, Lauro Cortigiani, José Luis de Castro e Silva Pretto, Alla A. Boshchenko, Doralisa Morrone, Milica Dekleva, Maria Chiara Scali, Giuseppe Limongelli, Federica Re, Ana Cristina Camarozano, Milorad Tesic, Iana Simova, Francesco Antonini-Canterin, Diego M. Lowenstein Haber, Quirino Ciampi, Fabio Lattanzi, Paolo Colonna, R Arbucci, Ines Monte, Valentina Lorenzoni, Nicola Gaibazzi, Fabio Mori, Branko Beleslin, Paul E Vargas Mieles, Hugo Rodríguez-Zanella, Giovanni Di Salvo, Gergely Ágoston, Bruno Villari, Marco Paterni, Eugenio Picano, Albert Varga, Rodolfo Citro, Marco Antonio Rodrigues Torres, Antonello D'Andrea, Costantina Prota, Nadezhda Zhuravskaya, Morrone, D., Arbucci, R., Wierzbowska-Drabik, K., Ciampi, Q., Peteiro, J., Agoston, G., Varga, A., Camarozano, A. C., Boshchenko, A., Ryabova, T., Dekleva, M., Simova, I., Lowenstein Haber, D. M., Tesic, M., Boskovic, N., Djordjevic-Dikic, A., Beleslin, B., D'Alfonso, M. G., Mori, F., Rodriguez-Zanella, H., Kasprzak, J. D., Cortigiani, L., Lattanzi, F., Scali, M. C., Torres, M. A. R., Daros, C. B., de Castro e Silva Pretto, J. L., Gaibazzi, N., Zagatina, A., Zhuravskaya, N., Amor, M., Mieles, P. E. V., Merlo, P. M., Monte, I., D'Andrea, A., Re, F., Di Salvo, G., Merli, E., Lorenzoni, V., De Nes, M., Paterni, M., Limongelli, G., Prota, C., Citro, R., Colonna, P., Villari, B., Antonini-Canterin, F., Carpeggiani, C., Lowenstein, J., and Picano, E.
- Subjects
Male ,Vasodilator Agents ,Vasodilation ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Logistic regression ,0302 clinical medicine ,Atrial Pressure ,Left atrial ,Dobutamine ,030212 general & internal medicine ,Prospective Studies ,Cardiac imaging ,Aged, 80 and over ,Dipyridamole ,Echocardiography ,Exercise ,Left atrial volume ,Stress ,Syndrome ,Middle Aged ,Europe ,Italy ,Adrenergic beta-1 Receptor Agonists ,Cardiology ,Atrial Function, Left ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Brazil ,medicine.drug ,Echocardiography, Stress ,medicine.medical_specialty ,Argentina ,Asymptomatic ,03 medical and health sciences ,Predictive Value of Tests ,Internal medicine ,medicine ,Stress Echocardiography ,Humans ,Radiology, Nuclear Medicine and imaging ,Heart Atria ,Aged ,Echocardiography, Doppler, Pulsed ,business.industry ,Chronic Disease ,Feasibility Studies ,business - Abstract
An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify left atrial volume (LAV) within minutes. Aim of this study was to assess the feasibility and functional correlates of LAV-stress echocardiography (SE) Out of 514 subjects referred to 10 quality-controlled labs, LAV-SE was completed in 490 (359 male, age 67 ± 12years) with suspected or known chronic coronary syndromes (n = 462) or asymptomatic controls (n = 28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAV was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. The intra-observer and inter-observer LAV variability were 5% and 8%, respectively. ∆-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r = −0.271, p < 0.001) and heart rate reserve (r = -.239, p < 0.001). LAV-dilators were defined as those with stress-rest increase ≥ 6.8ml/m2, a cutoff derived from a calculated reference change value above the biological, analytical and observer variability of LAVI. LAV dilation occurred in 56 patients (11%), more frequently with exercise (16%) and dipyridamole (13%) compared to dobutamine (4%, p < 0.01). At multivariable logistic regression analysis, B-lines ≥ 2 (OR: 2.586, 95% CI = 1.1293–5.169, p = 0.007) and abnormal contractile reserve (OR: 2.207, 95% CI = 1.111–4.386, p = 0.024) were associated with LAV dilation. In conclusion, LAV-SE is feasible with high success rate and low variability in patients with chronic coronary syndromes. LAV dilation is more likely with reduced left ventricular contractile reserve and pulmonary congestion.
- Published
- 2020
11. B-lines with Lung Ultrasound: The Optimal Scan Technique at Rest and During Stress
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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
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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
12. Coronary Flow, Left Ventricular Contractile and Heart Rate Reserve in Non-Ischemic Heart Failure
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Clarissa Borguezan Daros, Quirino Ciampi, Lauro Cortigiani, Nicola Gaibazzi, Fausto Rigo, Karina Wierzbowska-Drabik, Jaroslaw D. Kasprzak, Claudio Dodi, Bruno Villari, Francesco Antonini-Canterin, Valentina Lorenzoni, Michele De Nes, Clara Carpeggiani, Eugenio Picano, and on behalf of the Stress Echo Study Group of the Italian Society of Echocardiography and Cardiovascular Imaging
- Subjects
medicine.medical_specialty ,animal structures ,chronotropic incompetence ,stress echocardiography ,heart failure ,030204 cardiovascular system & hematology ,Article ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Internal medicine ,Heart rate ,Stress Echocardiography ,Medicine ,030212 general & internal medicine ,Ejection fraction ,business.industry ,General Medicine ,medicine.disease ,Dipyridamole ,medicine.anatomical_structure ,Heart failure ,Cardiology ,Chronotropic incompetence ,Coronary flow velocity reserve ,Stress echocardiography ,coronary flow velocity reserve ,business ,medicine.drug ,Artery - Abstract
Background: Left ventricular contractile reserve (LVCR), coronary flow velocity reserve (CFVR), and heart rate reserve (HRR) affect outcome in heart failure (HF). They can be simultaneously measured during dipyridamole stress echocardiography (DSE). Aim: To assess the value of comprehensive DSE in patients with non-ischemic HF. Methods: We evaluated 610 patients with HF, no history of coronary artery disease, and no inducible regional wall motion abnormalities: 270 patients with preserved ejection fraction (≥50%), 146 patients with mid-range ejection fraction (40–49%), and 194 patients with reduced ejection fraction (<, 40%). All underwent DSE (0.84 mg/kg in 6’) in 7 accredited laboratories. We measured LVCR (abnormal value ≤ 1.1), CFVR in left anterior descending artery (abnormal value: ≤2.0), and HRR (peak/rest heart rate, abnormal value: ≤1.22). All patients were followed up. Results: Abnormal CFVR, LVCR, and HRR occurred in 29%, 45%, and 47% of patients, respectively (p <, 0.001). After a median follow-up time of 20 months (interquartile range: 12–32 months), 113 hard events occurred in 105 patients with 41 deaths, 8 myocardial infarctions, 61 admissions for acute HF, and 3 strokes. The annual mortality rates were 0.8% in 200 patients with none abnormal criteria, 1.8% in 184 patients with 1 abnormal criterion, 7.1% in 130 patients with 2 abnormal criteria, 7.5% in 96 patients with 3 abnormal criteria. Conclusion: Abnormal LVCR, CFVR, and HRR were frequent during DSE in non-ischemic HF patients. They target different pathophysiological vulnerabilities (myocardial function, coronary microcirculation, and cardiac autonomic balance) and are useful for outcome prediction.
- Published
- 2021
13. Quality control of regional wall motion analysis in stress Echo 2020
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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
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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
14. Efeitos da aplicação da EPAP (Expiratory Positive Airway Pressure) sobre a tolerância ao esforço em pacientes portadores de insuficiência cardíaca Effects of the use of EPAP (Expiratory Positive Airway Pressure) on exercise tolerance in patients with heart failure
- Author
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Claudia Thofehrn, Mario Sérgio Soares de Azeredo Coutinho, Clarissa Borguezan Daros, Amberson Vieira de Assis, Renata Moraes de Lima, Christiani Decker Batista Bonin, and Magnus Benetti
- Subjects
expiratory positive pressure airway ,exercise ,exercício ,heart failure ,pressão positiva expiratória ,insuficiência cardíaca ,lcsh:Sports medicine ,lcsh:RC1200-1245 - Abstract
INTRODUÇÃO: Novas abordagens terapêuticas que objetivam melhorar a sensação de dispneia e fadiga em pacientes com insuficiência cardíaca, como a aplicação de pressão positiva expiratória nas vias aéreas (EPAP), podem ser aplicadas na tentativa de melhorar a capacidade funcional e a qualidade de vida. OBJETIVO: Avaliar os efeitos da utilização da EPAP ( Expiratory Positive Airway Pressure) durante o esforço em indivíduos portadores de IC classe funcional II e III (NYHA). MÉTODOS: Dos 390 pacientes, foram selecionados 28 com FEVE < 40%. O Teste de Caminhada de seis minutos (TC6') foi realizado três vezes: o primeiro para a familiarização, um com a máscara e o outro sem a máscara de EPAP, sendo válido os dois últimos. A comparação entre os dados obtidos foi realizada por meio de teste t de Student pareado ou teste de Wilcoxon, conforme a normalidade dos dados. RESULTADOS: a percepção de esforço foi maior após a caminhada com a utilização da máscara quando comparado na ausência da máscara. Houve elevação significativa na saturação de oxigênio quando os pacientes estavam usando a máscara de EPAP. CONCLUSÃO: O uso da máscara de EPAP aumenta a percepção de esforço e o trabalho ventilatório, porém, não aumentou a distância percorrida no TC6, sendo sua aplicabilidade questionável em programas de reabilitação cardiovascular.INTRODUCTION: New therapeutic approaches that aim to improve the sensation of dyspnea and fatigue in patients with heart failure, as the application of positive pressure airway expiratory (EPAP) Expiratory Positive Airway Pressure should be tested in an attempt to improve functional capacity and quality of life. OBJECTIVE: To evaluate the effects of the use of EPAP during exercise in patients with heart failure functional class II and III (NYHA). METHODS: Of 390 patients, 28 were selected with LVEF
- Published
- 2013
15. Efeitos da aplicação da EPAP (Expiratory Positive Airway Pressure) sobre a tolerância ao esforço em pacientes portadores de insuficiência cardíaca
- Author
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Magnus Benetti, Amberson Vieira de Assis, Mário Sérgio Soares de Azeredo Coutinho, Christiani Decker Batista Bonin, Clarissa Borguezan Daros, Renata Moraes de Lima, and Claudia Thofehrn
- Subjects
expiratory positive pressure airway ,exercise ,heart failure ,exercício ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,pressão positiva expiratória ,insuficiência cardíaca ,lcsh:Sports medicine ,lcsh:RC1200-1245 - Abstract
INTRODUÇÃO: Novas abordagens terapêuticas que objetivam melhorar a sensação de dispneia e fadiga em pacientes com insuficiência cardíaca, como a aplicação de pressão positiva expiratória nas vias aéreas (EPAP), podem ser aplicadas na tentativa de melhorar a capacidade funcional e a qualidade de vida. OBJETIVO: Avaliar os efeitos da utilização da EPAP ( Expiratory Positive Airway Pressure) durante o esforço em indivíduos portadores de IC classe funcional II e III (NYHA). MÉTODOS: Dos 390 pacientes, foram selecionados 28 com FEVE < 40%. O Teste de Caminhada de seis minutos (TC6') foi realizado três vezes: o primeiro para a familiarização, um com a máscara e o outro sem a máscara de EPAP, sendo válido os dois últimos. A comparação entre os dados obtidos foi realizada por meio de teste t de Student pareado ou teste de Wilcoxon, conforme a normalidade dos dados. RESULTADOS: a percepção de esforço foi maior após a caminhada com a utilização da máscara quando comparado na ausência da máscara. Houve elevação significativa na saturação de oxigênio quando os pacientes estavam usando a máscara de EPAP. CONCLUSÃO: O uso da máscara de EPAP aumenta a percepção de esforço e o trabalho ventilatório, porém, não aumentou a distância percorrida no TC6, sendo sua aplicabilidade questionável em programas de reabilitação cardiovascular. INTRODUCTION: New therapeutic approaches that aim to improve the sensation of dyspnea and fatigue in patients with heart failure, as the application of positive pressure airway expiratory (EPAP) Expiratory Positive Airway Pressure should be tested in an attempt to improve functional capacity and quality of life. OBJECTIVE: To evaluate the effects of the use of EPAP during exercise in patients with heart failure functional class II and III (NYHA). METHODS: Of 390 patients, 28 were selected with LVEF
- Published
- 2013
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