Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Imaging in Patients with Cardiovascular Implantable Electronic Devices: Part 1-Imaging Before and During Device Implantation. A Clinical Consensus Statement of the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association (EHRA) of the ESC(2023) Stankovic, Ivan; Voigt, Jens-Uwe; Burri, Haran; Muraru, Denisa; Sade, Leyla Elif; Haugaa, Kristina Hermann; Lumens, Joost; Biffi, Mauro; Dacher, Jean Nicolas; Marsan, Nina Ajmone; Bakelants, Elise; Manisty, Charlotte; Dweck, Marc R.; Smiseth, Otto A.; Donal, Erwan; 37861372More than 500 000 cardiovascular implantable electronic devices (CIEDs) are implanted in the European Society of Cardiology countries each year. The role of cardiovascular imaging in patients being considered for CIED is distinctly different from imaging in CIED recipients. In the former group, imaging can help identify specific or potentially reversible causes of heart block, the underlying tissue characteristics associated with malignant arrhythmias, and the mechanical consequences of conduction delays and can also aid challenging lead placements. On the other hand, cardiovascular imaging is required in CIED recipients for standard indications and to assess the response to device implantation, to diagnose immediate and delayed complications after implantation, and to guide device optimization. The present clinical consensus statement (Part 1) from the European Association of Cardiovascular Imaging, in collaboration with the European Heart Rhythm Association, provides comprehensive, up-to-date, and evidence-based guidance to cardiologists, cardiac imagers, and pacing specialists regarding the use of imaging in patients undergoing implantation of conventional pacemakers, cardioverter defibrillators, and resynchronization therapy devices. The document summarizes the existing evidence regarding the use of imaging in patient selection and during the implantation procedure and also underlines gaps in evidence in the field. The role of imaging after CIED implantation is discussed in the second document (Part 2).Item How To Assess Severe Tricuspid Regurgitation By Echocardiography?(2022) Sade, L. Elif; Muraru, Denisa; Marsan, Nina Ajmone; Agricola, Eustachio; Stankovic, Ivan; Donal, Erwan; https://orcid.org/0000-0003-3737-8595; 35136997; AAQ-7583-2021Item Left Atrial Function: The Hba1c For The Cardiologist And Even More COMMENT(2022) Donal, Erwan; Sade, L. Elif; Thomas, Liza; 35060246This article refers to 'Measures of left atrial function predict incident heart failure in a low-risk general population: the Copenhagen City Heart Study' by D.M. Andersen et al., published in this issue on pages xxx.Item The structural heart disease interventional imager rationale, skills and training: a position paper of the European Association of Cardiovascular Imaging(2021) Agricola, Eustachio; Ancona, Francesco; Brochet, Eric; Donal, Erwan; Dweck, Marc; Faletra, Francesco; Lancellotti, Patrizio; Mahmoud Elsayed, Hani; Marsan, Nina Ajmone; Maurovich Hovart, Pal; Monaghan, Mark; Ribeiro, Jose; Sade, Leyla Elif; Swaans, Martin; Von Bardeleben, Ralph Stephan; Wunderlich, Nina; Zamorano, Jose-Luis; Popescu, Bogdan A.; Cosyns, Bernard; Edvardsen, Thor; 0000-0003-3737-8595; 33564848; AAQ-7583-2021Percutaneous therapeutic options for an increasing variety of structural heart diseases (SHD) have grown dramatically. Within this context of continuous expansion of devices and procedures, there has been increased demand for physicians with specific knowledge, skills, and advanced training in multimodality cardiac imaging. As a consequence, a new subspecialty of 'Interventional Imaging' for SHD interventions and a new dedicated professional figure, the 'Interventional Imager' with specific competencies has emerged. The interventional imager is an integral part of the heart team and plays a central role in decision-making throughout the patient pathway, including the appropriateness and feasibility of a procedure, pre-procedural planning, intra-procedural guidance, and post-procedural follow-up. However, inherent challenges exist to develop a training programme for SHD imaging that differs from traditional cardiovascular imaging pathways. The purpose of this document is to provide the standard requirements for the training in SHD imaging, as well as a starting point for an official certification process for SHD interventional imager.Item Importance of Systematic Right Ventricular Assessment in Cardiac Resynchronization Therapy Candidates: A Machine Learning Approach(2021) Galli, Elena; Le Rolle, Virginie; Smiseth, Otto A.; Duchenne, Jurgen; Aalen, John M.; Larsen, Camilla K.; Sade, Elif A.; Hubert, Arnaud; Anilkumar, Smitha; Penicka, Martin; Linde, Cecilia; Leclercq, Christophe; Hernandez, Alfredo; Voigt, Jens-Uwe; Donal, Erwan; 33422667Background: Despite all having systolic heart failure and broad QRS intervals, patients screened for cardiac resynchronization therapy (CRT) are highly heterogeneous, and it remains extremely challenging to predict the impact of CRT devices on left ventricular function and outcomes. The aim of this study was to evaluate the relative impact of clinical, electrocardiographic, and echocardiographic data on the left ventricular remodeling and prognosis of CRT candidates by the application of machine learning approaches. Methods: One hundred ninety-three patients with systolic heart failure receiving CRT according to current recommendations were prospectively included in this multicenter study. A combination of the Boruta algorithm and random forest methods was used to identify features predicting both CRT volumetric response and prognosis. Model performance was tested using the area under the receiver operating characteristic curve. The k-medoid method was also applied to identify clusters of phenotypically similar patients. Results: From 28 clinical, electrocardiographic, and echocardiographic variables, 16 features were predictive of CRT response, and 11 features were predictive of prognosis. Among the predictors of CRT response, eight variables (50%) pertained to right ventricular size or function. Tricuspid annular plane systolic excursion was the main feature associated with prognosis. The selected features were associated with particularly good prediction of both CRT response (area under the curve, 0.81; 95% CI, 0.74-0.87) and outcomes (area under the curve, 0.84; 95% CI, 0.75-0.93). An unsupervised machine learning approach allowed the identification of two phenogroups of patients who differed significantly in clinical variables and parameters of biventricular size and right ventricular function. The two phenogroups had significantly different prognosis (hazard ratio, 4.70; 95% CI, 2.1-10.0; P < .0001; log-rank P < .0001). Conclusions: Machine learning can reliably identify clinical and echocardiographic features associated with CRT response and prognosis. The evaluation of both right ventricular size and functional parameters has pivotal importance for the risk stratification of CRT candidates and should be systematically performed in patients undergoing CRT. (J Am Soc Echocardiogr 2021;34:494-502.)Item Global evaluation of echocardiography in patients with COVID-19(2020) Dweck, Marc R.; Bularga, Anda; Hahn, Rebecca T.; Bing, Rong; Lee, Kuan Ken; Chapman, Andrew R.; White, Audrey; Di Salvo, Giovanni; Sade, Leyla Elif; Pearce, Keith; Newby, David E.; Popescu, Bogdan A.; Donal, Erwan; Cosyns, Bernard; Edvardsen, Thor; Mills, Nicholas L.; Haugaa, Kristina; 32556199Aims To describe the cardiac abnormalities in patients with COVID-19 and identify the characteristics of patients who would benefit most from echocardiography. Methods and results In a prospective international survey, we captured echocardiography findings in patients with presumed or confirmed COVID-19 between 3 and 20 April 2020. Patient characteristics, indications, findings, and impact of echocardiography on management were recorded. Multivariable logistic regression identified predictors of echocardiographic abnormalities. A total of 1216 patients [62 (52-71) years, 70% male] from 69 countries across six continents were included. Overall, 667 (55%) patients had an abnormal echocardiogram. Left and right ventricular abnormalities were reported in 479 (39%) and 397 (33%) patients, respectively, with evidence of new myocardial infarction in 36 (3%), myocarditis in 35 (3%), and takotsubo cardiomyopathy in 19 (2%). Severe cardiac disease (severe ventricular dysfunction or tamponade) was observed in 182 (15%) patients. In those without pre-existing cardiac disease (n = 901), the echocardiogram was abnormal in 46%, and 13% had severe disease. Independent predictors of left and right ventricular abnormalities were distinct, including elevated natriuretic peptides [adjusted odds ratio (OR) 2.96, 95% confidence interval (CI) 1.75-5.05) and cardiac troponin (OR 1.69, 95% CI 1.13-2.53) for the former, and severity of COVID-19 symptoms (OR 3.19, 95% CI 1.73-6.10) for the latter. Echocardiography changed management in 33% of patients. Conclusion In this global survey, cardiac abnormalities were observed in half of all COVID-19 patients undergoing echocardiography. Abnormalities were often unheralded or severe, and imaging changed management in one-third of patients.Item COVID-19 pandemic and cardiac imaging: EACVI recommendations on precautions, indications, prioritization, and protection for patients and healthcare personnel(2020) Skulstad, Helge; Cosyns, Bernard; Popescu, Bogdan A.; Galderisi, Maurizio; Di Salvo, Giovanni; Donal, Erwan; Petersen, Steffen; Gimelli, Alessia; Haugaa, Kristina H.; Muraru, Denisa; Almeida, Ana G.; Schulz-Menger, Jeanette; Dweck, Marc R.; Pontone, Gianluca; Sade, Leyla Elif; Gerber, Bernhard; Maurovich-Horvat, Pal; Bharucha, Tara; Cameli, Matteo; Magne, Julien; Westwood, Mark; Maurer, Gerald; Edvardsen, Thor; 32242891Item Training, competence, and quality improvement in echocardiography the European Association of Cardiovascular Imaging Recommendations: update 2020(2020) Popescu (Chair), Bogdan A.; Stefanidis, Alexandros; Fox, Kevin F.; Cosyns, Bernard; Delgado, Victoria; Di Salvo, Giovanni Di; Donal, Erwan; Flachskampf, Frank A.; Galderisi, Maurizio; Lancellotti, Patrizio; Muraru, Denisa; Sade, Leyla Elif; Edvardsen, Thor; 33245758The primary mission of the European Association of Cardiovascular Imaging (EACVI) is 'to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging'. Echocardiography is a key component in the evaluation of patients with known or suspected cardiovascular disease and is essential for the high quality and effective practice of clinical cardiology. The EACVI aims to update the previously published recommendations for training, competence, and quality improvement in echocardiography since these activities are increasingly recognized by patients, physicians, and payers. The purpose of this document is to provide the general requirements for training and competence in echocardiography, to outline the principles of quality evaluation, and to recommend a set of measures for improvement, with the ultimate goal of raising the standards of echocardiographic practice. Moreover, the document aims to provide specific guidance for advanced echo techniques, which have dramatically evolved since the previous publication in 2009.Item Rational and design of EuroCRT: an international observational study on multi-modality imaging and cardiac resynchronization therapy(2017) Sade, Elif; Donal, Erwan; Delgado, Victoria; Magne, Julien; Bucciarelli-Ducci, Chiara; Leclercq, Christophe; Cosyns, Bernard; Sitges, Marta; Edvardsen, Thor; Stankovic, Ivan; Agricola, Eustachio; Galderisi, Maurizio; Lancellotti, Patrizio; Hernandez, Alfredo; Plein, Sven; Muraru, Denisa; Schwammenthal, Ehud; Hindricks, Gerhard; Popescu, Bogdan A.; Habib, Gilbert; 28329299Aims Assessment of left ventricular (LV) volumes and ejection fraction (LVEF) with cardiac imaging is important in the selection of patients for cardiac resynchronization therapy (CRT). Several observational studies have explored the role of imaging-derived LV dyssynchrony parameters to predict the response to CRT, but have yielded inconsistent results, precluding the inclusion of imaging-derived LV dyssynchrony parameters in current guidelines for selection of patients for CRT. Methods The EuroCRT is a large European multicentre prospective observational study led by the European Association of Cardiovascular Imaging. We aim to explore if combing the value of cardiac magnetic resonance (CMR) and echocardiography could be beneficial for selecting heart failure patients for CRT in terms of improvement in long-term survival, clinical symptoms, LV function, and volumes. Speckle tracking echocardiography will be used to assess LV dyssynchrony and wasted cardiac work whereas myocardial scar will be assessed with late gadolinium contrast enhanced CMR. All data will be measured in core laboratories. The study will be conducted in European centres with known expertise in both CRT and multimodality cardiac imaging.Item Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging(2017) Sade, Leyla Elif; Galderisi, Maurizio; Cosyns, Bernard; Edvardsen, Thor; Cardim, Nuno; Delgado, Victoria; Di Salvo, Giovanni; Donal, Erwan; Ernande, Laura; Garbi, Madalina; Grapsa, Julia; Hagendorff, Andreas; Kamp, Otto; Magne, Julien; Santoro, Ciro; Stefanidis, Alexandros; Lancellotti, Patrizio; Popescu, Bogdan; Habib, Gilbert; 0000-0003-3737-8595; 29045589; AAQ-7583-2021Aims This European Association Cardiovascular Imaging (EACVI) Expert Consensus document aims at defining the main quantitative information on cardiac structure and function that needs to be included in standard echocardiographic report following recent ASE/EACVI chamber quantification, diastolic function, and heart valve disease recommendations. The document focuses on general reporting and specific pathological conditions such as heart failure, coronary artery and valvular heart disease, cardiomyopathies, and systemic diseases. Methods and results Demographic data (age, body surface area, blood pressure, and heart rhythm and rate), type (vendor and model) of ultrasound system used and image quality need to be reported. In addition, measurements should be normalized for body size. Reference normal values, derived by ASE/EACVI recommendations, shall always be reported to differentiate normal from pathological conditions. This Expert Consensus document suggests avoiding the surveillance of specific variable using different ultrasound techniques (e.g. in echo labs with high expertise in left ventricular ejection fraction by 3D and not by 2D echocardiography). The report should be also tailored in relation with different cardiac pathologies, quality of images, and needs of the caregivers. Conclusion The conclusion should be concise reflecting the status of left ventricular structure and function, the presence of left atrial and/or aortic dilation, right ventricular dysfunction, and pulmonary hypertension, leading to an objective communication with the patient health caregiver. Variation over time should be considered carefully, taking always into account the consistency of the parameters used for comparison.