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1. 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
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2. Lung Ultrasound and Pulmonary Congestion During Stress Echocardiography

Author

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.

Subjects
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)

Published
2020

3. Feasibility and functional correlates of left atrial volume changes during stress echocardiography in chronic coronary syndromes

Author

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

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