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JACC. Cardiovascular Imaging Nov 2018For a cardiologist, lung ultrasound is an add-on to transthoracic echocardiography, just as lung auscultation is part of a cardiac physical examination. A cardiac 3.5-... (Review)
Review
For a cardiologist, lung ultrasound is an add-on to transthoracic echocardiography, just as lung auscultation is part of a cardiac physical examination. A cardiac 3.5- to 5.0-MHz transducer is generally suitable because the small footprint makes it ideal for scanning intercostal spaces. The image quality is often adequate, and the lung acoustic window is always patent. The cumulative increase in imaging time is <1 min for the 2 main applications targeted on pleural water (pleural effusion) and lung water (pulmonary congestion as multiple B-lines). In these settings, lung ultrasound outperforms the diagnostic accuracy of the chest radiograph, with a low-cost, portable, real-time, radiation-free method. A "wet lung" detected by lung ultrasound predicts impending acute heart failure decompensation and may trigger lung decongestion therapy. The doctors of tomorrow may still listen with a stethoscope to their patient's lung, but they will certainly be seeing it with ultrasound.
Topics: Cardiologists; Echocardiography; Heart Diseases; Humans; Lung; Lung Diseases; Predictive Value of Tests; Prognosis; Ultrasonography
PubMed: 30409330
DOI: 10.1016/j.jcmg.2018.06.023 -
Clinical Research in Cardiology :... Feb 2024Many patients seen by cardiologists suffer chronic obstructive pulmonary disease (COPD) in addition to their primary cardiovascular problem. Yet, quite often COPD has... (Review)
Review
Many patients seen by cardiologists suffer chronic obstructive pulmonary disease (COPD) in addition to their primary cardiovascular problem. Yet, quite often COPD has not been diagnosed and, consequently, patients have not been treated of their pulmonary disease. Recognizing and treating COPD in patients with CVDs is important because optimal treatment of the COPD carries important benefits on cardiovascular outcomes. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) publishes an annual report that serves as a clinical guideline for the diagnosis and management of COPD around the world and has very recently released the 2023 annual report. Here, we provide a summary of the GOLD 2023 recommendations that highlights those aspects of more interest for practicing cardiologists dealing with patients with CVD who may suffer COPD.
Topics: Humans; Cardiologists; Pulmonary Disease, Chronic Obstructive; Lung
PubMed: 37233751
DOI: 10.1007/s00392-023-02217-0 -
Circulation Oct 2019Valvular heart disease (VHD) is an important cause of mortality and morbidity and has been subject to important changes in management. The VHD II survey was designed by... (Comparative Study)
Comparative Study Observational Study
BACKGROUND
Valvular heart disease (VHD) is an important cause of mortality and morbidity and has been subject to important changes in management. The VHD II survey was designed by the EURObservational Research Programme of the European Society of Cardiology to analyze actual management of VHD and to compare practice with guidelines.
METHODS
Patients with severe native VHD or previous valvular intervention were enrolled prospectively across 28 countries over a 3-month period in 2017. Indications for intervention were considered concordant if the intervention was performed or scheduled in symptomatic patients, corresponding to Class I recommendations specified in the 2012 European Society of Cardiology and in the 2014 American Heart Association/American College of Cardiology VHD guidelines.
RESULTS
A total of 7247 patients (4483 hospitalized, 2764 outpatients) were included in 222 centers. Median age was 71 years (interquartile range, 62-80 years); 1917 patients (26.5%) were ≥80 years; and 3416 were female (47.1%). Severe native VHD was present in 5219 patients (72.0%): aortic stenosis in 2152 (41.2% of native VHD), aortic regurgitation in 279 (5.3%), mitral stenosis in 234 (4.5%), mitral regurgitation in 1114 (21.3%; primary in 746 and secondary in 368), multiple left-sided VHD in 1297 (24.9%), and right-sided VHD in 143 (2.7%). Two thousand twenty-eight patients (28.0%) had undergone previous valvular intervention. Intervention was performed in 37.0% and scheduled in 26.8% of patients with native VHD. The decision for intervention was concordant with Class I recommendations in symptomatic patients with severe single left-sided native VHD in 79.4% (95% CI, 77.1-81.6) for aortic stenosis, 77.6% (95% CI, 69.9-84.0) for aortic regurgitation, 68.5% (95% CI, 60.8-75.4) for mitral stenosis, and 71.0% (95% CI, 66.4-75.3) for primary mitral regurgitation. Valvular interventions were performed in 2150 patients during the survey; of them, 47.8% of patients with single left-sided native VHD were in New York Heart Association class III or IV. Transcatheter procedures were performed in 38.7% of patients with aortic stenosis and 16.7% of those with mitral regurgitation.
CONCLUSIONS
Despite good concordance between Class I recommendations and practice in patients with aortic VHD, the suboptimal number in mitral VHD and late referral for valvular interventions suggest the need to improve further guideline implementation.
Topics: Aged; Aged, 80 and over; Cardiologists; Clinical Decision-Making; Europe; Female; Guideline Adherence; Health Care Surveys; Healthcare Disparities; Heart Valve Diseases; Humans; Male; Middle Aged; Practice Guidelines as Topic; Practice Patterns, Physicians'; Prospective Studies; Referral and Consultation; Time Factors; Time-to-Treatment
PubMed: 31510787
DOI: 10.1161/CIRCULATIONAHA.119.041080 -
Nature Apr 2023Artificial intelligence (AI) has been developed for echocardiography, although it has not yet been tested with blinding and randomization. Here we designed a blinded,... (Comparative Study)
Comparative Study Randomized Controlled Trial
Artificial intelligence (AI) has been developed for echocardiography, although it has not yet been tested with blinding and randomization. Here we designed a blinded, randomized non-inferiority clinical trial (ClinicalTrials.gov ID: NCT05140642; no outside funding) of AI versus sonographer initial assessment of left ventricular ejection fraction (LVEF) to evaluate the impact of AI in the interpretation workflow. The primary end point was the change in the LVEF between initial AI or sonographer assessment and final cardiologist assessment, evaluated by the proportion of studies with substantial change (more than 5% change). From 3,769 echocardiographic studies screened, 274 studies were excluded owing to poor image quality. The proportion of studies substantially changed was 16.8% in the AI group and 27.2% in the sonographer group (difference of -10.4%, 95% confidence interval: -13.2% to -7.7%, P < 0.001 for non-inferiority, P < 0.001 for superiority). The mean absolute difference between final cardiologist assessment and independent previous cardiologist assessment was 6.29% in the AI group and 7.23% in the sonographer group (difference of -0.96%, 95% confidence interval: -1.34% to -0.54%, P < 0.001 for superiority). The AI-guided workflow saved time for both sonographers and cardiologists, and cardiologists were not able to distinguish between the initial assessments by AI versus the sonographer (blinding index of 0.088). For patients undergoing echocardiographic quantification of cardiac function, initial assessment of LVEF by AI was non-inferior to assessment by sonographers.
Topics: Humans; Artificial Intelligence; Echocardiography; Stroke Volume; Ventricular Function, Left; Single-Blind Method; Workflow; Reproducibility of Results; Heart Function Tests; Cardiologists
PubMed: 37020027
DOI: 10.1038/s41586-023-05947-3 -
Nature Medicine Jan 2019Computerized electrocardiogram (ECG) interpretation plays a critical role in the clinical ECG workflow. Widely available digital ECG data and the algorithmic paradigm of...
Computerized electrocardiogram (ECG) interpretation plays a critical role in the clinical ECG workflow. Widely available digital ECG data and the algorithmic paradigm of deep learning present an opportunity to substantially improve the accuracy and scalability of automated ECG analysis. However, a comprehensive evaluation of an end-to-end deep learning approach for ECG analysis across a wide variety of diagnostic classes has not been previously reported. Here, we develop a deep neural network (DNN) to classify 12 rhythm classes using 91,232 single-lead ECGs from 53,549 patients who used a single-lead ambulatory ECG monitoring device. When validated against an independent test dataset annotated by a consensus committee of board-certified practicing cardiologists, the DNN achieved an average area under the receiver operating characteristic curve (ROC) of 0.97. The average F score, which is the harmonic mean of the positive predictive value and sensitivity, for the DNN (0.837) exceeded that of average cardiologists (0.780). With specificity fixed at the average specificity achieved by cardiologists, the sensitivity of the DNN exceeded the average cardiologist sensitivity for all rhythm classes. These findings demonstrate that an end-to-end deep learning approach can classify a broad range of distinct arrhythmias from single-lead ECGs with high diagnostic performance similar to that of cardiologists. If confirmed in clinical settings, this approach could reduce the rate of misdiagnosed computerized ECG interpretations and improve the efficiency of expert human ECG interpretation by accurately triaging or prioritizing the most urgent conditions.
Topics: Algorithms; Arrhythmias, Cardiac; Cardiologists; Electrocardiography; Humans; Monitoring, Ambulatory; Neural Networks, Computer; ROC Curve
PubMed: 30617320
DOI: 10.1038/s41591-018-0268-3 -
Circulation Jan 2019
Topics: Access to Information; Attitude of Health Personnel; Cardiologists; Health Communication; Health Knowledge, Attitudes, Practice; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Internet; Patient Acceptance of Health Care; Patient Safety; Risk Assessment; Social Media
PubMed: 30689419
DOI: 10.1161/CIRCULATIONAHA.118.039193 -
Arquivos Brasileiros de Cardiologia Feb 2022
Topics: Amyloidosis; Cardiologists; Humans
PubMed: 35262577
DOI: 10.36660/abc.20210959 -
Journal of the American College of... May 2021
Topics: Cardiologists; Cardiology; Education, Medical, Graduate; Humans
PubMed: 33926661
DOI: 10.1016/j.jacc.2021.02.061 -
Journal of the American College of... Sep 2017
Topics: Cardiologists; Cardiology; Father-Child Relations; Humans; Internship and Residency; Male; Personnel Staffing and Scheduling
PubMed: 28882240
DOI: 10.1016/j.jacc.2017.08.001 -
Journal of the American College of... Jul 2017
Topics: Cardiologists; Clinical Competence; Health Care Reform; Humans; Jurisprudence; Liability, Legal; Malpractice; Medical Errors; Risk Management; United States
PubMed: 28683971
DOI: 10.1016/j.jacc.2017.05.054