Update of the European Association of Cardiovascular Imaging (EACVI) Core Syllabus for the European Cardiovascular Magnetic Resonance Certification Exam

An updated version of the European Association of Cardiovascular Imaging (EACVI) Core Syllabus for the European Cardiovascular Magnetic Resonance (CMR) Certification Exam is now available online. The syllabus lists key elements of knowledge in CMR. It represents a framework for the development of training curricula and provides expected knowledge-based learning outcomes to the CMR trainees, in particular those intending to demonstrate CMR knowledge in the European CMR exam, a core requirement in the CMR certification process

EACVI survey on radiation exposure in interventional echocardiography.

AIMS: The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey on radiation exposure in interventional echocardiography. The survey aimed to collect data on local practices for radioprotection in interventional echocardiography and to assess the awareness of echocardiography operators about radiation-related risks. METHODS AND RESULTS: A total of 258 interventional echocardiographers from 52 different countries (48% European) responded to the survey. One hundred twenty-two (47%) participants were women. Two-thirds (76%) of interventional echocardiographers worked in tertiary care/university hospitals. Interventional echocardiography was the main clinical activity for 34% of the survey participants. The median time spent in the cath-lab for the echocardiographic monitoring of structural heart procedures was 10 (5-20) hours/month. Despite this, only 28% of interventional echocardiographers received periodic training and certification in radioprotection and 72% of them did not know their annual radiation dose. The main adopted personal protection devices were lead aprons and thyroid collars (95% and 92% of use, respectively). Dedicated architectural protective shielding was not available for 33% of interventional echocardiographers. Nearly two-thirds of responders thought that the radiation exposure of interventional echocardiographers was higher than that of interventional cardiologists and 72% claimed for an improvement in the radioprotection measures. CONCLUSION: Radioprotection measures for interventional echocardiographers are widely variable across centres. Radioprotection devices are often underused by interventional echocardiographers, portending an increased radiation-related risk. International scientific societies working in the field should collaborate to endorse radioprotection training, promote reliable radiation dose assessment, and support the adoption of radioprotection shielding dedicated to interventional echocardiographers

Peluang Peningkatan Tipe Terminal di Kecamatan Banyumaik (Analisis Demand dan Supply)

Kecamatan Banyumanik merupakan kecamatan yang terus mengalami perkembangan baik dari jumlah penduduk maupun pelayanan kotanya. Kecamatan ini juga berbatasan langsung dengan kabupaten Semarang dan menjadi gerbang koridor semarang atas atau semarang bagian Selatan sehingga memiliki pergerakan yang tinggi sebagai jalur keluar masuknya kota Semarang. Pergerakan yang tinggi tersebut tidak diimbangi dengan ketersediaan fasilitas transportasi pendukung yaitu terminal. Terminal merupakan salah satu fasilitas utama yang memiliki peran penting dalam sistem transportasi. Menurut keputusan menteri nomor 35 tahun 2003 pengertian terminal adalah prasarana transportasi jalan untuk keperluan memuat dan menurunkan orang dan/atau barang serta mengatur kedatangan dan pemberangkatan kendaraan umum, yang merupakan salah satu wujud simpul jaringan transportasi. Terminal juga memiliki peran yang penting sebagai unsur tata ruang dalam kaitannya untuk meningkatkan mobilitas dan efisiensi kehidupan kota. Terminal merupakan tempat untuk mengurangi kemacetan dimana dapat mengatur lokasi pergantian moda transportasi menjadi lebih teratur. Lokasi sebuah terminal harus sesuai dengan rencana tata ruang wilayah (RTRW) dan sesuai dengan kebutuhan masyarakat Di kecamatan Banyumanik hanya memiliki sub terminal atau terminal bantu yang berfungsi sebagai tempat transit dan pergantian moda. Demand yang tinggi terhadap fasilitas transportasi tersebut tidak sebanding dengan supply fasilitas terminal yang tersedia sehingga mengakibatkan timbulnya titik-titik baru yang digunakan masyarakat untuk menunggu angkutan yaitu terminal bayangan. Terminal bayangan ini muncul karena adanya demand yang tinggi dari mayarakat banyumanik terhadap kebutuhan sarana transportasi dan efisiensi waktu. Ketidakseimbangan antara demand dan supply ini mengakibatkan berbagai dampak makro maupun mikro terhadap lalu lintas maupun jaringan angkutan di Kecamatan Banyumanik dan kota Semarang

Knowledge co-production with traditional herders on cattle grazing behaviour for better management of species-rich grasslands

The research gap between rangeland/livestock science and conservation biology/vegetation ecology has led to a lack of evidence needed for grazing-related conservation management. Connecting scientific understanding with traditional ecological knowledge of local livestock keepers could help bridge this research and knowledge gap. We studied the grazing behaviour (plant selection and avoidance) of beef cattle (c. 33,000 bites) on species-rich lowland pastures in Central Europe and traditional herding practices. We also did >450 outdoor interviews with traditional herders about livestock behaviour, herders' decisions to modify grazing behaviour and effects of modified grazing on pasture vegetation. We found that cattle grazing on species-rich pastures displayed at least 10 different behavioural elements as they encountered 117 forage species from highly desired to rejected. The small discrimination error suggests that cattle recognize all listed plants ‘by species’. We also found that herders had broad knowledge of grazing desire and they consciously aimed to modify desire by slowing, stopping or redirecting the herd. Modifications were aimed at increasing grazing intensity in less-desired patches and decreasing grazing selectivity in heterogenous swards. Synthesis and applications. The traditional herd management practices presented here have significant conservation benefits, such as avoiding under- and overgrazing, and targeted removal of pasture weeds, litter and encroaching bushes, tall competitive plants and invasive species. We argue that knowledge co-production with traditional herders who belong to another knowledge system could help connect isolated scientific disciplines especially if ecologists and rangeland scientists work closely with traditional herders, co-designing research projects and working together in data collection, analysis and interpretation. Stronger links between these disciplines could help develop evidence-based, specific conservation management practices while herders could contribute with their practical experiences and with real-world testing of new management techniques.Fil: Molnár, Zsolt. Institute of Ecology and Botany; HungríaFil: Kelemen, András. Institute of Ecology and Botany; HungríaFil: Kun, Róbert. Szent István University. Department of Nature Conservation and Landscape Ecology; HungríaFil: Máté, János. Cattle Herder, Tatárszentgyörgy; HungríaFil: Sáfián, László. Cattle Herder, Tatárszentgyörgy; HungríaFil: Provenza, Fred. University of Utah; Estados UnidosFil: Díaz, Sandra Myrna. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Barani, Hossein. Gorgan University of Agricultural Sciences and Natural Resources; IránFil: Biró, Marianna. GINOP Sustainable Ecosystems Group; HungríaFil: Máté, András. Dorcadion Kft; HungríaFil: Vadász, Csaba. Kiskunság National Park; Hungrí

The multi-modality cardiac imaging approach to the Athlete's heart: an expert consensus of the European Association of Cardiovascular Imaging.

The term 'athlete's heart' refers to a clinical picture characterized by a slow heart rate and enlargement of the heart. A multi-modality imaging approach to the athlete's heart aims to differentiate physiological changes due to intensive training in the athlete's heart from serious cardiac diseases with similar morphological features. Imaging assessment of the athlete's heart should begin with a thorough echocardiographic examination.Left ventricular (LV) wall thickness by echocardiography can contribute to the distinction between athlete's LV hypertrophy and hypertrophic cardiomyopathy (HCM). LV end-diastolic diameter becomes larger (>55 mm) than the normal limits only in end-stage HCM patients when the LV ejection fraction is <50%. Patients with HCM also show early impairment of LV diastolic function, whereas athletes have normal diastolic function.When echocardiography cannot provide a clear differential diagnosis, cardiac magnetic resonance (CMR) imaging should be performed.With CMR, accurate morphological and functional assessment can be made. Tissue characterization by late gadolinium enhancement may show a distinctive, non-ischaemic pattern in HCM and a variety of other myocardial conditions such as idiopathic dilated cardiomyopathy or myocarditis. The work-up of athletes with suspected coronary artery disease should start with an exercise ECG. In athletes with inconclusive exercise ECG results, exercise stress echocardiography should be considered. Nuclear cardiology techniques, coronary cardiac tomography (CCT) and/or CMR may be performed in selected cases. Owing to radiation exposure and the young age of most athletes, the use of CCT and nuclear cardiology techniques should be restricted to athletes with unclear stress echocardiography or CMR

The rationale of opportunistic bilateral salpingectomies (OBS) during benign gynaecological and obstetric surgery : a consensus text of the Flemish Society of Obstetrics and Gynaecology (VVOG)

Ovarian cancer (OC), is a disease difficult to diagnose in an early stage implicating a poor prognosis. The 5-year overall survival in Belgium has not changed in the last 18 years and remains 44 %. There is no effective screening method (secondary prevention) to detect ovarian cancer at an early stage. Primary prevention of ovarian cancer came in the picture through the paradigm shift that the fallopian tube is often the origin of ovarian cancer and not the ovary itself. Opportunistic bilateral salpingectomy (OBS) during benign gynaecological and obstetric surgery might have the potential to reduce the risk of ovarian cancer by as much as 65 %. Bilateral risk-reducing salpingectomy during a benign procedure is feasible, safe, appears to have no impact on the ovarian function and seems to be cost effective. The key question is whether we should wait for a RCT or implement OBS directly in our daily practice. Guidelines regarding OBS within our societies are therefore urgently needed. Our recommendation is to inform all women without a child wish, undergoing a benign gynaecological or obstetrical surgical procedure about the pro’s and the con’s of OBS and advise a bilateral salpingectomy. Furthermore, there is an urgent need for a prospective registry of OBS. The present article is the consensus text of the Flemish Society of Obstetrics and Gynaecology (VVOG) regarding OBS

Role of multimodality cardiac imaging in the management of patients with hypertrophic cardiomyopathy: an expert consensus of the European Association of Cardiovascular Imaging Endorsed by the Saudi Heart Association.

Taking into account the complexity and limitations of clinical assessment in hypertrophic cardiomyopathy (HCM), imaging techniques play an essential role in the evaluation of patients with this disease. Thus, in HCM patients, imaging provides solutions for most clinical needs, from diagnosis to prognosis and risk stratification, from anatomical and functional assessment to ischaemia detection, from metabolic evaluation to monitoring of treatment modalities, from staging and clinical profiles to follow-up, and from family screening and preclinical diagnosis to differential diagnosis. Accordingly, a multimodality imaging (MMI) approach (including echocardiography, cardiac magnetic resonance, cardiac computed tomography, and cardiac nuclear imaging) is encouraged in the assessment of these patients. The choice of which technique to use should be based on a broad perspective and expert knowledge of what each technique has to offer, including its specific advantages and disadvantages. Experts in different imaging techniques should collaborate and the different methods should be seen as complementary, not as competitors. Each test must be selected in an integrated and rational way in order to provide clear answers to specific clinical questions and problems, trying to avoid redundant and duplicated information, taking into account its availability, benefits, risks, and cost

3D echocardiographic reference ranges for normal left ventricular volumes and strain: Results fromthe EACVI NORRE study

Aim To obtain the normal ranges for 3D echocardiography (3DE) measurement of left ventricular (LV) volumes, function, and strain from a large group of healthy volunteers. Methods and results A total of 440 (mean age: 45613 years) out of the 734 healthy subjects enrolled at 22 collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study had good-quality 3DE data sets that have been analysed with a vendor-independent software package allowing homogeneous measurements regardless of the echocardiographic machine used to acquire the data sets. Upper limits of LV end-diastolic and end-systolic volumes were larger in men (97 and 42 mL/m2) than in women (82 and 35 mL/m2; P<0.0001). Conversely, lower limits of LV ejection fraction were higher in women than in men (51% vs. 50%; P<0.01). Similarly, all strain components were higher in women than in men. Lower range was -18.6% in men and -19.5% in women for 3D longitudinal strain, -27.0% and -27.6% for 3D circumferential strain, -33.2% and -34.4% for 3D tangential strain and 38.8% and 40.7% for 3D radial strain, respectively. LV volumes decreased with age in both genders (P<0.0001), whereas LV ejection fraction increased with age only in men. Among 3DE LV strain components, the only one, which did not change with age was longitudinal strain. Conclusion The NORRE study provides applicable 3D echocardiographic reference ranges for LV function assessment. Our data highlight the importance of age- and gender-specific reference values for both LV volumes and strain. All rights reserved

The role of cardiovascular imaging for myocardial injury in hospitalized COVID-19 patients

This is a pre-copyedited, author-produced version of an article accepted for publication in European Heart Journal - Cardiovascular Imaging, following peer review. The version of record: Bernard Cosyns, Stijn Lochy, Maria Luiza Luchian, Alessia Gimelli, Gianluca Pontone, Sabine D Allard, Johan de Mey, Peter Rosseel, Marc Dweck, Steffen E Petersen, Thor Edvardsen, on behalf of the European Association of Cardiovascular Imaging (EACVI), The role of cardiovascular imaging for myocardial injury in hospitalized COVID-19 patients, European Heart Journal - Cardiovascular Imaging, Volume 21, Issue 7, July 2020, Pages 709–714, https://doi.org/10.1093/ehjci/jeaa136 is available online at: https://doi.org/10.1093/ehjci/jeaa13

Outcomes of Patients with Asymptomatic Aortic Stenosis Followed Up in Heart Valve Clinics

Importance: The natural history and the management of patients with asymptomatic aortic stenosis (AS) have not been fully examined in the current era. Objective: To determine the clinical outcomes of patients with asymptomatic AS using data from the Heart Valve Clinic International Database. Design, Setting, and Participants: This registry was assembled by merging data from prospectively gathered institutional databases from 10 heart valve clinics in Europe, Canada, and the United States. Asymptomatic patients with an aortic valve area of 1.5 cm2 or less and preserved left ventricular ejection fraction (LVEF) greater than 50% at entry were considered for the present analysis. Data were collected from January 2001 to December 2014, and data were analyzed from January 2017 to July 2018. Main Outcomes and Measures: Natural history, need for aortic valve replacement (AVR), and survival of asymptomatic patients with moderate or severe AS at entry followed up in a heart valve clinic. Indications for AVR were based on current guideline recommendations. Results: Of the 1375 patients included in this analysis, 834 (60.7%) were male, and the mean (SD) age was 71 (13) years. A total of 861 patients (62.6%) had severe AS (aortic valve area less than 1.0 cm2). The mean (SD) overall survival during medical management (mean [SD] follow up, 27 [24] months) was 93% (1%), 86% (2%), and 75% (4%) at 2, 4, and 8 years, respectively. A total of 104 patients (7.6%) died under observation, including 57 patients (54.8%) from cardiovascular causes. The crude rate of sudden death was 0.65% over the duration of the study. A total of 542 patients (39.4%) underwent AVR, including 388 patients (71.6%) with severe AS at study entry and 154 (28.4%) with moderate AS at entry who progressed to severe AS. Those with severe AS at entry who underwent AVR did so at a mean (SD) of 14.4 (16.6) months and a median of 8.7 months. The mean (SD) 2-year and 4-year AVR-free survival rates for asymptomatic patients with severe AS at baseline were 54% (2%) and 32% (3%), respectively. In those undergoing AVR, the 30-day postprocedural mortality was 0.9%. In patients with severe AS at entry, peak aortic jet velocity (greater than 5 m/s) and LVEF (less than 60%) were associated with all-cause and cardiovascular mortality without AVR; these factors were also associated with postprocedural mortality in those patients with severe AS at baseline who underwent AVR (surgical AVR in 310 patients; transcatheter AVR in 78 patients). Conclusions and Relevance: In patients with asymptomatic AS followed up in heart valve centers, the risk of sudden death is low, and rates of overall survival are similar to those reported from previous series. Patients with severe AS at baseline and peak aortic jet velocity of 5.0 m/s or greater or LVEF less than 60% have increased risks of all-cause and cardiovascular mortality even after AVR. The potential benefit of early intervention should be considered in these high-risk patients