ABSTRACT
Imaging plays an integral role in all aspects of managing heart disease and cardiac imaging is a core competency of cardiologists. The adequate delivery of cardiac imaging services requires expertise in both imaging methodology-with specific adaptations to imaging of the heart-as well as intricate knowledge of heart disease. The European Society of Cardiology (ESC) and the European Association of Cardiovascular Imaging have developed and implemented a successful education and certification programme for all cardiac imaging modalities. This programme equips cardiologists to provide high quality competency-based cardiac imaging services ensuring they are adequately trained and competent in the entire process of cardiac imaging, from the clinical indication via selecting the best imaging test to answer the clinical question, to image acquisition, analysis, interpretation, storage, repository, and results dissemination. This statement emphasizes the need for competency-based cardiac imaging delivery which is key to optimal, effective and efficient, patient care.
Subject(s)
Cardiology , Cardiovascular Nursing , Heart Diseases , Heart Failure , Humans , HeartABSTRACT
AIMS: The provision of high-quality education allows the European Society of Cardiology (ESC) to achieve its mission of better cardiovascular practice and provides an essential component of translating new evidence to improve outcomes. METHODS AND RESULTS: The 4th ESC Education Conference, held in Sophia Antipolis (December 2016), brought together ESC education leaders, National Directors of Training of 43 ESC countries, and representatives of the ESC Young Community. Integrating national descriptions of education and cardiology training, we discussed innovative pathways to further improve knowledge and skills across different training programmes and health care systems. We developed an ESC roadmap supporting better cardiology training and continued medical education (CME), noting: (i) The ESC provides an excellent framework for unbiased and up-to-date cardiovascular education in close cooperation with its National Societies. (ii) The ESC should support the harmonization of cardiology training, curriculum development, and professional dialogue and mentorship. (iii) ESC congresses are an essential forum to learn and discuss the latest developments in cardiovascular medicine. (iv) The ESC should create a unified, interactive educational platform for cardiology training and continued cardiovascular education combining Webinars, eLearning Courses, Clinical Cases, and other educational programmes, along with ESC Congress content, Practice Guidelines and the next ESC Textbook of Cardiovascular Medicine. (v) ESC-delivered online education should be integrated into National and regional cardiology training and CME programmes. CONCLUSION: These recommendations support the ESC to deliver excellent and comprehensive cardiovascular education for the next generation of specialists. Teamwork between international, national and local partners is essential to achieve this objective.
Subject(s)
Cardiology , Education, Medical, Continuing/organization & administration , Societies, Medical/organization & administration , Cardiology/education , Cardiology/organization & administration , Europe , Humans , Practice Guidelines as TopicABSTRACT
Imaging plays an integral role in all aspects of managing heart disease and cardiac imaging is a core competency of cardiologists. The adequate delivery of cardiac imaging services requires expertise in both imaging methodology-with specific adaptations to imaging of the heart-as well as intricate knowledge of heart disease. The European Society of Cardiology (ESC) and the European Association of Cardiovascular Imaging have developed and implemented a successful education and certification programme for all cardiac imaging modalities. This programme equips cardiologists to provide high quality competency-based cardiac imaging services ensuring they are adequately trained and competent in the entire process of cardiac imaging, from the clinical indication via selecting the best imaging test to answer the clinical question, to image acquisition, analysis, interpretation, storage, repository, and results dissemination. This statement emphasizes the need for competency-based cardiac imaging delivery which is key to optimal, effective and efficient, patient care.
Subject(s)
Cardiology , Cardiovascular Nursing , Heart Diseases , Heart Failure , Humans , HeartABSTRACT
Imaging plays an integral role in all aspects of managing heart disease and cardiac imaging is a core competency of cardiologists. The adequate delivery of cardiac imaging services requires expertise in both imaging methodology-with specific adaptations to imaging of the heart-as well as intricate knowledge of heart disease. The European Society of Cardiology (ESC) and the European Association of Cardiovascular Imaging have developed and implemented a successful education and certification programme for all cardiac imaging modalities. This programme equips cardiologists to provide high quality competency-based cardiac imaging services ensuring they are adequately trained and competent in the entire process of cardiac imaging, from the clinical indication via selecting the best imaging test to answer the clinical question, to image acquisition, analysis, interpretation, storage, repository, and results dissemination. This statement emphasizes the need for competency-based cardiac imaging delivery which is key to optimal, effective and efficient, patient care.
Subject(s)
Aortic Valve Prolapse/microbiology , Candidiasis/diagnosis , Dizziness/etiology , Adult , Aortic Valve Prolapse/diagnosis , Aortic Valve Prolapse/surgery , Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/microbiology , Aortic Valve Stenosis/surgery , Candidiasis/complications , Echocardiography, Doppler, Color , Heart Valve Prosthesis Implantation , Humans , Incidental Findings , Male , Tomography, X-Ray ComputedABSTRACT
The 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.
Subject(s)
Cardiology , Cardiovascular Diseases , Cardiovascular Diseases/diagnostic imaging , Echocardiography , Europe , Humans , Quality Improvement , Societies, MedicalABSTRACT
AIMS: To assess the feasibility of conducting a large-scale quality-control exercise on the echocardiographic grading of mitral regurgitation (MR). METHODS AND RESULTS: One hundred and fifty-two practising cardiologist and sonographer echocardiographers attended a dedicated session within a national meeting and were asked to review echocardiographic images of five case studies and evaluate the severity of MR using a six-point scale. The group's overall evaluation was analysed together with the variation in grading of severity. The proportion of gradings of MR more than one grade either side of the mode was <10% in all but one case, and <10% were inaccurately evaluated as inside categories of severe when the modal grading was outside and vice versa. However in a case where a single grading difference had important clinical implications, substantial variability was seen. CONCLUSIONS: Conducting a large-scale quality-control exercise in the assessment of mitral regurgitation is feasible. Overall results suggesting reasonable consistency in reporting may hide substantial clinically relevant variability. It is essential that increasing importance is attached to the development, conduct, and analysis of quality control within echocardiography if it is to maintain and extend its role as a key investigation for patients with heart disease.
Subject(s)
Echocardiography/standards , Mitral Valve Insufficiency/diagnostic imaging , Quality of Health Care , Feasibility Studies , Humans , Mitral Valve Insufficiency/pathology , Quality Control , United KingdomABSTRACT
The main mission statement of the European Association of Echocardiography (EAE) is 'to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular ultrasound in Europe'. As competence and quality control issues are increasingly recognized by patients, physicians, and payers, the EAE has established recommendations for training, competence, and quality improvement in echocardiography. The purpose of this document is to provide the requirements for training and competence in echocardiography, to outline the principles of quality measurement, and to recommend a set of measures for improvement, with the ultimate goal of raising the standards of echocardiographic practice in Europe.
Subject(s)
Echocardiography/standards , Certification , Clinical Competence , Curriculum/standards , Education, Medical, Continuing/standards , Education, Medical, Graduate/standards , Europe , Humans , Quality Control , Societies, MedicalABSTRACT
One of the missions of the European Association of Cardiovascular Imaging (EACVI) is 'to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging'. The future of imaging involves multimodality so each imager should have the incentive and the possibility to improve its knowledge in other cardiovascular techniques. This article presents the results of a 20 questions survey carried out in cardiovascular imaging (CVI) centres across Europe. The aim of the survey was to assess the situation of experience and training of CVI in Europe, the availability and organization of modalities in each centre and to ask for vision about potential improvements in CVI at national and European level.
Subject(s)
Multimodal Imaging , Europe , Humans , Surveys and QuestionnairesABSTRACT
Anaemia is common in severe chronic heart failure and is reported to be a predictor of death. We investigated 552 patients (median age 76 years, range 29-95; 54% men [n=296]), in whom the duration of heart failure was sufficiently short that it would be unlikely to affect haemoglobin concentrations. By contrast with studies in established chronic heart failure, haemoglobin was not independently associated with prognosis when age and serum creatinine concentration were included in the analysis. The adverse effects of anaemia on survival might be a consequence of chronic heart failure rather than a separate process causing disease progression.
Subject(s)
Cardiac Output, Low/blood , Hemoglobins/analysis , Adult , Age Factors , Aged , Aged, 80 and over , Anemia/blood , Anemia/diagnosis , Cardiac Output, Low/diagnosis , Cardiac Output, Low/mortality , Creatinine/blood , Disease Progression , Female , Follow-Up Studies , Heart Failure/blood , Heart Failure/diagnosis , Heart Failure/mortality , Humans , Male , Middle Aged , Prognosis , Proportional Hazards Models , Survival AnalysisABSTRACT
BACKGROUND: Current epidemiological evidence suggests that the prevalence of preserved systolic function in patients with heart failure varies widely from 13 to 74%. This inconsistency suggests a lack of consensus as to what this condition really is and how it has been characterised for epidemiological studies. AIMS: In this review, we summarise and discuss the current understanding of the epidemiology of heart failure with preserved systolic function and the challenges that this raises. METHODS: Studies were identified from Medline and Embase Literature Database searches using the subject headings heart failure, diastolic heart failure, epidemiology, incidence, prevalence, diagnosis, prognosis and mortality. RESULTS: Sixty-one studies of congestive heart failure with preserved systolic function were reviewed. There is great diversity in the criteria used to determine whether heart failure is present, the patient population, the setting of the study and methods of evaluating left ventricular function. This makes epidemiological studies of prevalence, morbidity and mortality impossible to compare. CONCLUSIONS: The diagnosis of this syndrome might be better defined in terms of symptoms, elevated neuro hormones and impaired cardiac workload. This would allow accurate identification of cases so that further research could be conducted to measure outcome and assess therapeutic benefit.
Subject(s)
Blood Pressure/physiology , Heart Failure/epidemiology , Heart Failure/physiopathology , Diastole , Heart Failure/mortality , Humans , Morbidity , Prevalence , Prognosis , SystoleABSTRACT
AIMS: The aim of the study was to examine ventricular remodelling in patients free of cardiac risk factors, before, and 6 months post-bariatric surgery with the new imaging modality of three-dimensional (3D) strain and the comparison of two surgical techniques: sleeve gastrectomy vs. gastric bypass. METHODS AND RESULTS: Fifty-two consecutive patients referred to the Bariatric Services of Imperial College NHS Trust were examined with conventional 2D and 3D strain echocardiography, prior to and 6 months after bariatric surgery. They were all free from cardiac disease. The study cohort's mean age was 44.2 ± 8.7 years and body mass index of 42.4 ± 4.6 g/m(2) prior to surgery. Eighteen patients (34.6%) underwent laparoscopic sleeve gastrectomy, and 34 laparoscopic gastric bypass. On 3D speckle tracking, there was significant reverse remodelling post-bariatric surgery [left ventricular (LV) ejection fraction (EF): pre-surgery: 59 ± 8% vs. post-surgery: 67 ± 7%, P < 0.001 and right ventricular (RV) EF: pre-surgery: 60 ± 9% vs. post-surgery: 68 ± 8.2%, P = 0.0001]. Furthermore, there was significant regression of mass (LV mass: pre-surgery: 111 ± 23.5 g vs. post-surgery: 92.8 ± 15.5 g and RV mass: pre-surgery: 95.2 ± 19.8 vs. post-surgery: 67.3 ± 16.3, P < 0.001). RV and LV global strain improved 6 months post-bariatric surgery: global RV strain: pre-surgery -11.7 ± 4 vs. post-surgery -17.52 ± 3.7, P < 0.001; global LV strain: pre-surgery: -20.2 ± 1.7 vs. post-surgery: -26.5 ± 1.86, P < 0.001. Sleeve gastrectomy and gastric bypass had comparable effects. CONCLUSION: Bariatric surgery has an important effect in reverse LV and RV remodelling and it substantially improves RV longitudinal strain.
Subject(s)
Bariatric Surgery/methods , Echocardiography, Three-Dimensional , Ventricular Remodeling , Adult , Body Mass Index , Female , Humans , Image Interpretation, Computer-Assisted , Male , Prospective StudiesABSTRACT
Standards for echocardiographic laboratories were proposed by the European Association of Echocardiography (now the European Association of Cardiovascular Imaging) 7 years ago, to raise standards of practice and improve the quality of care. Criteria and requirements were published at that time for transthoracic, transoesophageal, and stress echocardiography. This paper reassesses and updates the quality standards to take account of experience and the technical developments of modern echocardiographic practice. It also discusses quality control, the incentives for laboratories to apply for accreditation, the re-accreditation criteria, and the current status and future prospects of the laboratory accreditation process.
Subject(s)
Accreditation , Echocardiography/standards , Laboratories/standards , Europe , Quality Control , Societies, MedicalABSTRACT
Standards for echocardiographic laboratories were proposed by the European Association of Echocardiography (now the European Association of Cardiovascular Imaging) 7 years ago in order to raise standards of practice and improve the quality of care. Criteria and requirements were published at that time for transthoracic, transoesophageal, and stress echocardiography. This paper reassesses and updates the quality standards to take account of experience and the technical developments of modern echocardiographic practice. It also discusses quality control, the incentives for laboratories to apply for accreditation, the reaccreditation criteria, and the current status and future prospects of the laboratory accreditation process.
Subject(s)
Accreditation/standards , Cardiology Service, Hospital/standards , Echocardiography/standards , Practice Guidelines as Topic/standards , Cardiac Imaging Techniques/standards , Cardiac Imaging Techniques/trends , Cardiology Service, Hospital/trends , Echocardiography/trends , Echocardiography, Stress/standards , Echocardiography, Transesophageal/standards , Europe , Forecasting , Humans , Laboratories, Hospital/standards , Quality Control , Reference Standards , Societies, Medical/standardsSubject(s)
Cardiology/education , Certification , Clinical Competence , Education, Medical, Graduate/methods , Internship and Residency/methods , Tomography, X-Ray Computed/standards , Cardiac Imaging Techniques/standards , Curriculum , Education, Medical, Continuing/standards , Europe , Female , Humans , Male , Tomography, X-Ray Computed/methodsABSTRACT
Different pathophysiologic pathways in the development of left ventricular (LV) hypertrophy can be reflected in phenotypical differences. A total of 119 subjects (39 with hypertension [HTN]; 43 with nonobstructive hypertrophic cardiomyopathy [HC], and 37 control subjects) underwent a standardized cardiac magnetic resonance imaging protocol for assessment of global and regional morphology and function using balanced steady-state free precession sequences and late gadolinium enhancement studies. Compared to controls, both hypertrophic groups had significantly greater maximal wall thickness and LV mass index (p <0.01). The patients with HTN had reduced ejection fraction, increased heart cavities, and increased LV wall stress (p <0.01). The HC group had supernormal ejection fraction and reduced LV wall stress (p <0.01). The HTN group had reduced anteroseptal systolic strains (p <0.02), and the HC group displayed a marked decrease in longitudinal systolic strain (p <0.01). In the HC group, an inverse relation was seen between a globally increased late gadolinium enhancement score and the ejection fraction (r = -0.5, p = 0.01), and between regional late gadolinium enhancement scores and regional systolic strain in the inferoseptal segments. Increased LV wall stress was identified as the hallmark of HTN (odds ratio 1.2, p = 0.002), while HC was best characterized by reduced total longitudinal strain (odds ratio 1.3, p = 0.002). In conclusion, our findings indicate the presence of distinctive hypertrophic phenotypes detectable by means of multiparametric magnetic resonance imaging. In HTN, impaired deformation follows the distribution of LV wall stress. On the contrary, HC is characterized by reduced global and regional deformation, in association with fibrosis.