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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EHighlights from the 2014 recommendations of European cardiovascular imaging societies on best practice for medical imaging in the areas of chamber quantification, cardiomyopathies, vascular imaging, and aortic diseases were presented at a recent symposium. Staying current on recommendation updates is essential for community cardiologists.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Echamber quantification\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiomyopathy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Evascular imaging\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eaortic disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ehypertrophic cardiomyopathy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eechocardiography\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eatherosclerosis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ehypertension\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EHighlights from the 2014 recommendations of the European Society of Cardiology (ESC) and the European Association of Cardiovascular Imaging (EACVI) on cardiovascular (CV) imaging were reviewed by representatives in a joint session between EACVI Club 35 and ESC Cardiologists of Tomorrow. The symposium was divided into 4 sections: chamber quantification, cardiomyopathies, vascular imaging, and aortic diseases. Symposia such as these can be very useful for community cardiologists, allowing them to stay abreast of best practices emerging from clinical research in a time-efficient manner.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EDenisa Muraru, MD, PhD, University of Padua, Padua, Italy, delivered a presentation on the updated recommendations on cardiac chamber quantification, documented by the American Society of Echocardiography (ASE) and the EACVI. Dr Muraru first briefly reviewed previous recommendations on chamber quantification published in 2005 and again in 2010. Addressing the issue of why an update was needed now, Dr Muraru cited new echocardiographic techniques that have entered the clinical arena since 2005, such as myocardial deformation imaging and 3D echocardiography (3DE). In addition, larger numbers, stricter criteria of normality, more evidence, and multicenter normative studies have led to the emergence of more robust data, warranting a reappraisal of existent recommendations. New guidelines were also needed in order to unify minor discrepancies in limits of normality between the 2005 edition and more recent echocardiography guidelines, said Dr Muraru.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ERegarding what has been changed in the updated ASE\/EACVI recommendations for chamber quantification, Dr Muraru mentioned that the majority of normal limits for conventional measures of chamber size and function have been revised, and new recommendations have been included for global longitudinal strain, 3D echo volumes, and ejection fraction for both left and right ventricles. In addition, partition values for severity have been questioned, and there have been revisions to sex and body surface area normalized cutoffs, with additional stratifications by age and race, where available. Recommendations on general measurement principles of all cardiac chambers, aorta, and inferior vena cava have been updated and illustrated by numerous figures. Finally, the recommendation to use the same normal ranges for ventricular dimensions and volumes by both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) has been also included in the document.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIn conclusion, Dr Muraru said that this extensive update on cardiac chamber quantification in adults will be published in January 2015 by the ASE and EACVI and will provide new, more reliable reference values for conventional echocardiographic measurements, as well as normative values for 3DE and myocardial deformation imaging.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EA presentation on the guidelines on diagnosis and management of hypertrophic cardiomyopathy (HCM) [Elliot PM et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E. 2014] from the ESC Task Force for the Diagnosis and Management of HCM was delivered by Ricardo Fontes-Carvalho, MD, Gaia Hospital Center, University of Porto, Porto, Portugal. The key messages from the task force for imaging cardiologists regarding HCM were to always focus on a clinically based approach, recognizing the diverse range of conditions that can cause the disease, and to take a systematic and individualized approach to diagnosis and treatment in management of left ventricular (LV) outflow tract obstruction. Exploring features of the systematic approach to echocardiography in HCM patients that was encouraged by the task force, Dr Fontes-Carvalho listed a careful examination of chamber walls, in particular assessing LV wall thickness, as well as looking for obstruction by including the use of provocation such as the Valsalva maneuver. The task force also emphasized the importance of involving multidisciplinary teams with HCM expertise in care of those patients and reminded echocardiographers to request and interpret genetic tests when clinically relevant. Included in the recommendations was specific advice for women with HCM regarding reproductive- and pregnancy-related issues. However, the feature of the recommendations that received the most advance coverage was the development of a new risk calculator for the prevention of sudden cardiac death in HCM.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe diagnostic criteria for adult HCM are an LV wall thickness \u2265\u200915 mm in \u2265\u20091 LV myocardial segments, as measured by echocardiography, cardiac magnetic resonance imaging, or computed tomography (CT), that cannot be explained solely by loading conditions. Genetic and nongenetic disorders can present with slightly less wall thickening (13 to 14 mm). In such a situation, diagnosis of HCM requires evaluation of family history, noncardiac signs and symptoms, electrocardiogram abnormalities, laboratory tests, and multimodal cardiac imaging. A detailed assessment of the mitral valve was also described as key, with the presence of a centrally or anteriorly directed jet of regurgitation indicating potential intrinsic valve abnormality rather than HCM-related systolic anterior motion of the mitral valve, where the jet is directed posterolaterally. Summarizing the key messages from the task force on best practices for cardiac imaging in patients with HCM, Dr Fontes-Carvalho said that multimodality imaging is essential in the evaluation of patients with HCM, and there is an increasing need to integrate cardiac imaging in the clinical context of the disease. Because the success of invasive procedures for therapy depends on detailed imaging as well as careful planning and teamwork, the importance of a systematic approach to use of cardiac imaging techniques in the evaluation and support of treatment for HCM patients was again emphasized.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EIn the presentation committed to recommendations for vascular imaging, Iana Simova, MD, PhD, National Cardiology Hospital, Sofia, Bulgaria, explained that were no new ESC\/EACVI guidelines for vascular imaging in 2014 but that new guidelines on best use of these useful tools for CV risk assessment could be published in 2015. The 2012 version of the European guidelines on CV disease prevention in clinical practice [Perk J et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E. 2012] says that measurement of carotid intima-media thickness (IMT) and\/or screening for atherosclerotic plaques by carotid artery scanning should be considered for CV risk assessment in asymptomatic adults at moderate risk. Thickening of intima-media (IM) complex is a feature of arterial wall aging and is the first structural change to be detected in atherosclerosis. While IM thickening represents an important risk marker, it is not synonymous with subclinical atherosclerosis and has not been proven as a treatment target. According to the Society of Atherosclerosis Imaging and Prevention, in collaboration with the International Atherosclerosis Society [\u003Cem\u003EAtherosclerosis.\u003C\/em\u003E 2011], it is appropriate to measure IMT in patients at intermediate risk for coronary artery disease (CAD), in patients with metabolic syndrome aged \u0026gt;\u200930 years, and in patients with diabetes without a history of CAD.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EMoving on to hypertension recommendations, Dr Simova reviewed the 2013 European Society of Hypertension\/ESC guidelines for the management of arterial hypertension [\u003Cem\u003EEur Heart J\u003C\/em\u003E. 2013; \u003Cem\u003EHypertens.\u003C\/em\u003E 2013; \u003Cem\u003EJ Hypertens\u003C\/em\u003E. 2013]. Risk stratification in hypertensive patients examines asymptomatic organ (artery) damage, as indicated by pulse pressure \u2265\u200960 mm Hg in the elderly, carotid-femoral pulse wave velocity \u0026gt;\u200910 m\/s, an ankle-brachial index (ABI)\u2009\u0026lt;\u20090.9, carotid wall thickening (IMT\u2009\u0026gt;\u20090.9 mm), or evidence of plaques. Plaques are defined as focal structures that either encroach \u2265\u20090.5 mm into the arterial lumen or to a depth of \u2265\u200950% of the IMT value at their location or demonstrate a thickness \u0026gt;\u20091.5 mm between the intima-lumen to media adventitia interfaces [Touboul PJ. \u003Cem\u003ECerebrovasc Dis.\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EESC guidelines on the diagnosis and treatment of peripheral artery diseases [\u003Cem\u003EEur Heart J.\u003C\/em\u003E 2011] are focused on measurement of the ABI as a first-line, noninvasive test for screening and diagnosis of lower extremity arterial disease. This test has some limitations, as in the case of noncompressible ankle arteries or ABI\u2009\u0026gt;\u20091.40. In such situations, alternative methods should be used, such as the toe-brachial index, Doppler waveform analysis, or pulse volume recording.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EIn the final portion of the symposium, Rafael Vidal-Perez, Hospital Universitario Lucus Augusti, Lugo, Spain, covered the 2014 ESC guidelines on the diagnosis and treatment of aortic diseases, a document drafted by a task force of \u0026gt;\u200920 top European cardiologists [\u003Cem\u003EEur Heart J.\u003C\/em\u003E 2014]. According to Dr Vidal-Perez, their recommendations constitute \u201c10 commandments\u201d for the treatment of acute and chronic disease of the adult thoracic and abdominal aorta. As such, it is the first-ever guideline on aortic diseases to consider the thoracic and abdominal aorta as a single organ, and it includes recommendation on the treatment of not only aortic syndromes but also aortic aneurysms, aortic tumors, aortic inflammation, and both genetic and congenital diseases. Highlights include recommendation of an additional 2-minute scan of the abdominal aorta for all elderly patients undergoing TTE to screen for abdominal aortic aneurysm. A comprehensive list of standard values was supplied for all imaging techniques, as well as a flowchart designed for emergency room use to increase speed and efficiency of decision making in treatment of acute aortic syndromes, where survival can depend on quick and correct decision making.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EDr Vidal-Perez described the aorta as the ultimate conduit, one that carries nearly 200 million L of blood during an average lifetime. Aortic diameters in healthy adults usually do not exceed 40 mm and can be influenced by sex, body size, and blood pressure. Age also affects size, with an expansion in aortic diameter of about 0.9 mm per decade in men and 0.7 mm per decade in women. Imaging workups for aortic diseases usually involve \u0026gt;\u20091 technique. The ESC guidelines also provide a comparison of methods used in aortic imaging, including TTE, TEE, CT, magnetic resonance imaging, and aortography (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). These were ranked by ease of use, cost, diagnostic reliability, bedside interventional use, serial examinations, aortic wall visualization, radiation, and nephrotoxicity.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11595\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11595\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11595\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-13\u0022 class=\u0022first-child\u0022\u003EComparison of Methods for Imaging the Aorta\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-20\u0022\u003EIn conclusion, Dr Vidal-Perez said that further studies are needed to determine what combinations of imaging modalities can provide the most accurate, reproducible, and predictive measurements of the aorta. Growing use of 3D imaging and other dynamic imaging methods for the prediction of complications in aneurysmal disease mandates that the superiority of these new techniques over traditional 2D size measurement be tested.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/54\/22.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzobw1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzobw1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}