2024 CSANZ Position Statement on Indications, Assessment and Monitoring of Structural and Valvular Heart Disease With Transthoracic Echocardiography in Adults.

Transthoracic echocardiography (TTE) is the most widely available and utilised imaging modality for the screening, diagnosis, and serial monitoring of all abnormalities related to cardiac structure or function. The primary objectives of this document are to provide (1) a guiding framework for treating clinicians of the acceptable indications for the initial and serial TTE assessments of the commonly encountered cardiovascular conditions in adults, and (2) the minimum required standard for TTE examinations and reporting for imaging service providers. The main areas covered within this Position Statement pertain to the TTE assessment of the left and right ventricles, valvular heart diseases, pericardial diseases, aortic diseases, infective endocarditis, cardiac masses, pulmonary hypertension, and cardiovascular diseases associated with cancer treatments or cardio-oncology. Facilitating the optimal use and performance of high quality TTEs will prevent the over or under-utilisation of this resource and unnecessary downstream testing due to suboptimal or incomplete studies.

Same evidence different recommendations: a methodological assessment of transatlantic guidelines for the management of valvular heart disease.

OBJECTIVES: The aim of this study was to identify methodological variations leading to varied recommendations between the American College of Cardiology (ACC)/American Heart Association (AHA) and the European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) valvular heart disease guidelines and to suggest foundational steps towards standardizing guideline development. METHODS: An in-depth analysis was conducted to evaluate the methodologies used in developing the transatlantic guidelines for managing valvular heart disease. The evaluation was benchmarked against the standards proposed by the Institute of Medicine. RESULTS: Substantial discrepancies were noted in the methodologies utilized in development processes, including Writing Committee composition, evidence evaluation, conflict of interest management and voting processes. Furthermore, despite their mutual differences, both methodologies demonstrate notable deviations from the Institute of Medicine standards in several essential areas, including literature review and evidence grading. These dual variances likely influenced divergent treatment recommendations. For example, the ESC/EACTS recommends transcatheter edge-to-edge repair for patients with chronic severe mitral regurgitation ineligible for mitral valve surgery, while the ACC/AHA recommends transcatheter edge-to-edge repair based on anatomy, regardless of surgical risk. ESC/EACTS guidelines recommend a mechanical aortic prosthesis for patients under 60, while ACC/AHA guidelines recommend it for patients under 50. Notably, the ACC/AHA and ESC/EACTS guidelines have differing age cut-offs for surgical over transcatheter aortic valve replacement (<65 and <75 years, respectively). CONCLUSIONS: Variations in methodologies for developing clinical practice guidelines have resulted in different treatment recommendations that may significantly impact global practice patterns. Standardization of essential processes is vital to increase the uniformity and credibility of clinical practice guidelines, ultimately improving healthcare quality, reducing variability and enhancing trust in modern medicine.

2017 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary

The International Liaison Committee on Resuscitation has initiated a near-continuous review of cardiopulmonary resuscitation science that replaces the previous 5-year cyclic batch-and-queue approach process. This is the first of an annual series of International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations summary articles that will include the cardiopulmonary resuscitation science reviewed by the International Liaison Committee on Resuscitation in the previous year. The review this year includes 5 basic life support and 1 pediatric Consensuses on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Each of these includes a summary of the science and its quality based on Grading of Recommendations, Assessment, Development, and Evaluation criteria and treatment recommendations. Insights into the deliberations of the International Liaison Committee on Resuscitation task force members are provided in Values and Preferences sections. Finally, the task force members have prioritized and listed the top 3 knowledge gaps for each population, intervention, comparator, and outcome question

Avaliação do conhecimento dos cardiologistas sobre diretrizes do tratamento da fibrilação atrial / Assessment of the adherence of cardiologists to guidelines for the treatment of atrial fibrillation

FUNDAMENTO: Não existem estudos locais avaliando o conhecimento dos cardiologistas sobre as condutas no tratamento da fibrilação atrial (FA) e o conhecimento dessas diretrizes. OBJETIVO: Avaliar o conhecimento de diretrizes e práticas clínicas no tratamento da FA, relacionando-o com o tempo de graduação médica. MÉTODOS: Estudo transversal incluindo, aleatoriamente, cardiologistas, membros da Sociedade de Cardiologia do Estado do Rio Grande do Sul (SOCERGS). Os médicos foram divididos pelas datas de graduação em dois grupos: acima (G1) e abaixo (G2) de 25 anos da formatura. RESULTADOS: Dos 859 membros da SOCERGS, 150 foram entrevistados, sendo que seis se recusaram a participar do estudo. O G1 foi formado por 71 e o G2 por 73 médicos. Houve diferença nos seguintes fatores: uso de beta bloqueador como droga de primeira escolha para controle da resposta na FA 59,2%(G1) vs. 91,8%(G2) (p<0,0001); uso de digoxina como droga preferencial no controle da resposta da FA=19,7%(G1) vs. 0% (G2)(p< 0,0001); warfarina como anticoagulante preferencial 71,8%(G1) vs. 93,2%(G2)(p=0,009); aplicação de algum escore de risco para anticoagulação em 73,2%(G1) vs. 87,7%(G2)(p=0,02). Em questões sobre o conhecimento das diretrizes da Sociedade Brasileira de Cardiologia de FA, o percentual geral de acertos foi de 82,3 %. CONCLUSÃO: A maioria das condutas clínicas referentes ao manejo da FA está de acordo com as diretrizes e a prática clínica difere conforme o tempo de graduação.

BACKGROUND: No local studies evaluating the knowledge of cardiologists on the management of atrial fibrillation (AF) and their adherence to these guidelines are available. OBJECTIVE: To evaluate the knowledge of cardiologists on the guidelines and clinical practices for the treatment of AF, correlating it to the time since medical graduation. METHODS: Cross-sectional study randomly including cardiologists affiliated to the Society of Cardiology of the State of Rio Grande do Sul (Sociedade de Cardiologia do Estado do Rio Grande do Sul - SOCERGS). The physicians were divided into two groups, according to time since graduation: those graduated for more (G1) or less (G2) than 25 years. RESULTS: Of the 859 SOCERGS members, 150 were interviewed, and six refused to participate in the study. G1 comprised 71 physicians, and G2, 73. Differences were observed in regard to the following variables: use of betablockers as the first-choice drug for the control of AF response in 59.2% (G1) vs 91.8% (G2) (p<0.0001); use of digoxin as the preferred drug for the control of AF response in 19.7% (G1) vs 0% (G2) (p< 0.0001); warfarin as the preferred anticoagulant in 71.8% (G1) vs 93.2% (G2) (p=0.009); application of a risk score for anticoagulation in 73.2% (G1) vs 87.7% (G2) (p=0.02). In questions regarding the knowledge about the Brazilian Society of Cardiology's guideline for AF, the overall percentage of right answers was 82.3%. CONCLUSION: Most of the clinical measures regarding the management of AF comply with the guidelines, and the clinical practice differs according with the time since graduation.

Valoración del riesgo cardíaco antes de cirugía no cardíaca: papel de las pruebas adicionales

La información que puede esperarse de la monitorización electrocardiografica de las pruebas de estrés denámicas o farmacológicas y de la arteriografía coronaria en pacientes con riesgo de eventos cardiovasculares perioperatorios resulta fundamental

Principios básicos de la valoración del riesgo cardíaco antes de cirugía no cardiáca

Existen ciertos principios universalmente aplicables a la valoración prequirúrgica del riesgo cardíaco en cirugia no cardíaca culquiera que sea el procedimiento programado o cualquiera que sean las enfermedades concomitantes. En próxinos articulos se abordarán pruebas adicionales y consideraciones especiales con respecto al tratamiento trasoperatorio y postoperatorio