Quality control of B-lines analysis in stress Echo 2020

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 < .01), the first attempt success rate was higher (43 vs 28%, p < 0.01), and the drop-out of readers smaller (0 vs 28%, p < .01). Conclusions Web-based learning is highly effective for teaching and harmonizing B-lines reading. Echocardiographers without previous experience with B-lines learn quickly.info:eu-repo/semantics/publishedVersio

New insights into regional systolic and diastolic left ventricular function with tissue Doppler echocardiography: From qualitative analysis to a quantitative approach

Tissue Doppler echocardiography is a variation of conventional Doppler now imaging. This modality allows quantification of the Doppler shift within the range of myocardial tissue motion The velocity at a variety of myocardial sites can be determined and distinguished very rapidly by using Doppler techniques. The velocity of moving tissue can be studied with pulsed wave tissue Doppler sampling, which displays the velocity of a selected myocardial region against time, with high temporal resolution. In addition, the velocities can be calculated with time-velocity maps and displayed as color-encoded velocity maps in either an M-mode or 2-dimensional format. This review will focus on the technical aspects and the different methods of tissue Doppler echocardiography for the analysis of regional systolic and diastolic left ventricular function. Whereas pulsed wave tissue Doppler echocardiography allows measurements of velocities of a selected myocardial region, color tissue Doppler gives the best overview of cardiac dynamics because the entire scanned color data are displayed simultaneously. However,there is an increasing need for objective evaluation of tissue Doppler information Digital images and postprocessing of the data allow for quantitative off-line analysis, and the different approaches and parameters proposed from different centers are discussed

Ecografia in unità di terapia intensiva cardiologica

ecografia in Urgenza in Terapia intensiva coronaric

Ventriculo-arterial coupling in the intensive cardiac care unit: a non-invasive prognostic parameter

Aims: The aim of this study was to investigate the relationship between ventriculo-arterial coupling (VAC) and in-hospital outcomes and to assess the prognostic value of VAC in critically ill patients. Methods and results: A total of 329 consecutive patients (mean age 66,7&nbsp;±&nbsp;15.5&nbsp;years, 66.9% male) admitted to the intensive cardiac care unit of the Sandro Pertini Hospital, Rome (Italy) between January 2019 and December 2019, were included in the study. All patients underwent blood pressure measurement and non-invasive, echocardiography-derived estimates of left ventricular end-systolic elastance (Ees), arterial elastance (Ea) and VAC in a single-beat determination using the iElastance© application. In-hospital events related to acute heart failure and hypoperfusion were recorded and need for invasive ventilation, intra-aortic balloon pump, renal replacement therapy and death were considered as composite. Overall, 39 patients (11,8%) experienced in-hospital complications (group C), and 290 (88,2%) did not (group NoC). Ea and VAC were found to be significantly higher in group C than in group NoC, and a trend toward decreased Ees was observed in group C. VAC was a strong and independent predictor of in-hospital clinical outcome both at univariable and multivariable analysis adjusted for comorbidities [OR (95% CI): 1.868 (1.141-3.059); P&nbsp;=&nbsp;0.013] and hemodynamic parameters [OR (95% CI): 1674 (1018-2755); P&nbsp;=&nbsp;0.042]. Conclusion: VAC might be an additional non-invasive prognosticator of outcome in critically ill patients