Use of cardiac imaging in chronic coronary syndromes: the EURECA Imaging registry.

BACKGROUND: The prospective, multicentre EURECA registry assessed the use of imaging and adoption of the European Society of Cardiology (ESC) Guidelines (GL) in patients with chronic coronary syndromes (CCS). METHODS: Between May 2019 and March 2020, 5156 patients were recruited in 73 centres from 24 ESC member countries. The adoption of GL recommendations was evaluated according to clinical presentation and pre-test probability (PTP) of obstructive coronary artery disease (CAD). RESULTS: The mean age of the population was 64 ± 11 years, 60% of patients were males, 42% had PTP >15%, 27% had previous CAD, and ejection fraction was <50% in 5%. Exercise ECG was performed in 32% of patients, stress imaging as the first choice in 40%, and computed tomography coronary angiography (CTCA) in 22%. Invasive coronary angiography (ICA) was the first or downstream test in 17% and 11%, respectively. Obstructive CAD was documented in 24% of patients, inducible ischaemia in 19%, and 13% of patients underwent revascularization. In 44% of patients, the overall diagnostic process did not adopt the GL. In these patients, referral to stress imaging (21% vs. 58%; P < 0.001) or CTCA (17% vs. 30%; P < 0.001) was less frequent, while exercise ECG (43% vs. 22%; P < 0.001) and ICA (48% vs. 15%; P < 0.001) were more frequently performed. The adoption of GL was associated with fewer ICA, higher proportion of diagnosis of obstructive CAD (60% vs. 39%, P < 0.001) and revascularization (54% vs. 37%, P < 0.001), higher quality of life, fewer additional testing, and longer times to late revascularization. CONCLUSIONS: In patients with CCS, current clinical practice does not adopt GL recommendations on the use of diagnostic tests in a significant proportion of patients. When the diagnostic approach adopts GL recommendations, invasive procedures are less frequently used and the diagnostic yield and therapeutic utility are superior.

International consensus statement on challenges for women in cardiovascular practice and research in the COVID-19 era.

The challenges to academic and professional development and career advancement of women in cardiology (WIC), imposed by the pandemic, not only impinge the female cardiologists' "leaky pipeline" but also make the "leakiness" more obvious. This consensus document aims to highlight the pandemic challenges WIC face, raise awareness of the gender equity gap, and propose mitigating actionable solutions derived from the data and experiences of an international group of female cardiovascular clinicians and researchers. This changing landscape has led to the need for highly specialized cardiologists who may have additional training in critical care, imaging, advanced heart failure, or interventional cardiology. Although women account for most medical school graduates, the number of WIC, particularly in mentioned sub-specialties, remains low. Moreover, women have been more affected by systemic issues within these challenging work environments, limiting their professional progression, career advancement, and economic potential. Therefore, it is imperative that tangible action points be noted and undertaken to ensure the representation of women in leadership, advocacy, and decision-making, and increase diversity in academia. Strategies to mitigate the negative impacts of the pandemic need to be taken during this COVID-19 pandemic to ensure WIC have a place in the field of Cardiology.

Cardiac Imaging on COVID-19 Pandemic Era: the Stand, The Lost, and Found.

Purpose of Review: The present review will outline the main effects of COVID-19 pandemic on cardiovascular pathologies, focusing on the role of modern non-invasive cardiac imaging techniques in this setting. Recent Findings: Multimodality cardiac imaging seems particularly suited for the in-depth characterization of patients with COVID-19, allowing the assessment of the variegated impact of the disease on the different aspects of myocardial perfusion, structure, and function. Summary: The infection of SARS-CoV-2, leading to the coronavirus disease-19 (COVID-19), has represented a consistent challenge for the organization of the healthcare systems, associating to a significant increase of the fatality rate of different acute and chronic disease. Moreover, the reallocation of healthcare providers led to a significant reduction of the availability of tests and therapies, with the deferral of non-urgent tests and non-lifesaving procedures.

Cardiac Imaging on COVID-19 Pandemic Era: the Stand, The Lost, and Found

Purpose of Review The present review will outline the main effects of COVID-19 pandemic on cardiovascular pathologies, focusing on the role of modern non-invasive cardiac imaging techniques in this setting. Recent Findings Multimodality cardiac imaging seems particularly suited for the in-depth characterization of patients with COVID-19, allowing the assessment of the variegated impact of the disease on the different aspects of myocardial perfusion, structure, and function. Summary The infection of SARS-CoV-2, leading to the coronavirus disease-19 (COVID-19), has represented a consistent challenge for the organization of the healthcare systems, associating to a significant increase of the fatality rate of different acute and chronic disease. Moreover, the reallocation of healthcare providers led to a significant reduction of the availability of tests and therapies, with the deferral of non-urgent tests and non-lifesaving procedures.

[Lung ultrasonography: what the cardiologist should know]. / Ecografia del polmone: quello che il cardiologo dovrebbe conoscere.

In recent years, lung ultrasonography has acquired an important role as a valuable diagnostic tool in clinical practice. The lung is usually poorly explorable, but it provides more acoustic information in pathological conditions that modify the relationship between air, water and tissues. The different acoustic impedance of all these components makes the chest wall a powerful ultrasound reflector: this is responsible for the creation of several artifacts providing valuable information about lung pathophysiology. Lung ultrasonography helps in the diagnostic process of parenchymal and pleural pathologies, in the differential diagnosis of dyspnea and in the clinical and prognostic evaluation of the SARS-CoV-2 infection.

[Non-ischemic ventricular dysfunction in COVID-19 patients: characteristics and implications for cardiac imaging on the basis of current evidence]. / La disfunzione ventricolare non ischemica nei pazienti con COVID-19: caratteristiche e implicazioni per l'imaging cardiaco in base alle attuali evidenze scientifiche.

Coronavirus 2019 disease (COVID-19), caused by SARS-CoV-2, can lead to cardiac impairment with various types of clinical manifestations, including heart failure and cardiogenic shock. A possible expression of cardiac impairment is non-ischemic ventricular dysfunction, which can be related to different pathological conditions, such as myocarditis, stress and cytokine-related ventricular dysfunction. The diagnosis of these pathological conditions can be challenging during COVID-19; furthermore, their prevalence and prognostic significance have not been elucidated yet. The purpose of this review is to take stock of the various aspects of non-ischemic ventricular dysfunction that may occur during COVID-19 and of the diagnostic implications related to the use of cardiac imaging techniques.

The role of cardiovascular imaging for myocardial injury in hospitalized COVID-19 patients.

Recent EACVI recommendations described the importance of limiting cardiovascular imaging during the COVID-19 pandemic in order to reduce virus transmission, protect healthcare professionals from contamination, and reduce consumption of personal protective equipment. However, an elevated troponin remains a frequent request for cardiac imaging in COVID-19 patients, partly because it signifies cardiac injury due to a variety of causes and partly because it is known to convey a worse prognosis. The present paper aims to provide guidance to clinicians regarding the appropriateness of cardiac imaging in the context of troponin elevation and myocardial injury, how best to decipher the mechanism of myocardial injury, and how to guide patient management.

[The role of multimodality imaging in COVID-19 patients: from diagnosis to clinical monitoring and prognosis]. / L'imaging integrato nel percorso del paziente con COVID-19: dalla diagnosi, al monitoraggio clinico, alla prognosi.

The integrated clinical, laboratory and ultrasound approach is essential for the diagnosis, monitoring and evaluation of the patient's therapy in COVID-19 pneumonia. The ideal imaging strategy in this setting is not yet well defined. Bedside pulmonary ultrasound presents an undeniable series of advantages in patients at high risk of infection, and can provide incremental data in the respiratory intensive care for the serial control of the individual patient, as well as for home delivery of stabilized patients. Chest X-ray is characterized by low sensitivity in identifying earlier lung changes. Pulmonary computed tomography shows high sensitivity but should not be routinely performed in all patients, because in the first 48 h it can be absolutely negative, and in the late phase imaging findings may not change the therapeutic approach. Echocardiography should be limited to patients with hemodynamic instability.