Recommendations for the practice of echocardiography in infective endocarditis.
Eur J Echocardiogr. 2010 Mar;11(2):202-19
Authors: Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, Voigt JU, Sicari R, Co…

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Improved workflow, sonographer productivity, and cost-effectiveness of echocardiographic service for inpatients by using miniaturized systems.

Eur J Echocardiogr. 2009 Jun;10(4):537-42

Authors: Badano LP, Nucifora G, Stacul S, Gianfagna P, Pericoli M, Del Mestre L, Buiese S, Compassi R, Tonutti G, Di Benedetto L, Fioretti PM

AIMS: The aim of this study was to assess the cost-effectiveness of using certified sonographers and miniaturized echocardiography systems to perform echocardiograms at bedside in comparison to moving inpatients from the admission department to the echocardiography laboratory (echo-lab). METHODS AND RESULTS: From 26 September 2005 to 27 October 2005, 112 patients admitted in six hospital wards connected through a 100 Mbit LAN to the echo-lab were scanned within the admission ward by sonographers using a miniaturized echo system. Logistical data were collected and results were compared with those obtained from 194 consecutive patients coming from the same wards and studied in the echo-lab with high-end machines between 8 March 2005 and 15 April 2005. Performing echocardiograms in the admission department avoided long waiting time of the inpatients in the echo-lab before and after the study, increased the percentage of patients studied within 3 and 5 days from request (88 vs. 77% and 100 vs. 95%, respectively; P = 0.03), increased both sonographer (by 33.9%; P < 0.001) and echo-lab productivity (by 41%; P < 0.001), and reduced costs of echocardiograms by 29%. CONCLUSION: Implementation of digital echocardiography, certified sonographers, and a miniaturized echo system allowed improvement of the cost-effectiveness of the service provided by the echo-lab for inpatients, and avoided patients' discomfort derived from prolonged waiting time before and after the exam.

PMID: 19252189 [PubMed - indexed for MEDLINE]

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Non-invasive assessment of coronary flow and coronary flow reserve by transthoracic Doppler echocardiography: a magic tool for the real world.

Eur J Echocardiogr. 2008 Jul;9(4):449-57

Authors: Meimoun P, Tribouilloy C

Transthoracic Doppler echocardiography, introduced in the echo-lab in recent last years, to measure coronary flow and coronary flow reserve, is a very attractive tool, totally non-invasive, and easily available at bedside. This review summarizes the actual possibilities of this tool, its multiple potential clinical applications and diagnostic insights, and its arising prognosis value, in coronary artery disease as in various settings affecting the coronary microcirculation.

PMID: 18296409 [PubMed - indexed for MEDLINE]

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Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC).

Eur J Echocardiogr. 2008 Jul;9(4):415-37

Authors: Sicari R, Nihoyannopoulos P, Evangelista A, Kasprzak J, Lancellotti P, Poldermans D, Voigt JU, Zamorano JL,

Stress echocardiography is the combination of 2D echocardiography with a physical, pharmacological or electrical stress. The diagnostic end point for the detection of myocardial ischemia is the induction of a transient worsening in regional function during stress. Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician. Among different stresses of comparable diagnostic and prognostic accuracy, semisupine exercise is the most used, dobutamine the best test for viability, and dipyridamole the safest and simplest pharmacological stress and the most suitable for combined wall motion coronary flow reserve assessment. The additional clinical benefit of myocardial perfusion contrast echocardiography and myocardial velocity imaging has been inconsistent to date, whereas the potential of adding – coronary flow reserve evaluation of left anterior descending coronary artery by transthoracic Doppler echocardiography adds another potentially important dimension to stress echocardiography. New emerging fields of application taking advantage from the versatility of the technique are Doppler stress echo in valvular heart disease and in dilated cardiomyopathy. In spite of its dependence upon operator’s training, stress echocardiography is today the best (most cost-effective and risk-effective) possible imaging choice to achieve the still elusive target of sustainable cardiac imaging in the field of noninvasive diagnosis of coronary artery disease.

PMID: 18579481 [PubMed - indexed for MEDLINE]

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