velocity, aortic root dimensions) Green: Departments must also provide evidence that the whole team is involved in the process, and provide evidence of feedback and quality improvement 2B Audit Amber: Two audits per year (these could be
Thomas E Ingram, Steph Baker, Jane Allen, Sarah Ritzmann, Nina Bual, Laura Duffy, Chris Ellis, Karina Bunting, Noel Black, Marcus Peck, Sandeep S Hothi, Vishal Sharma, Keith Pearce, Richard P Steeds, Navroz Masani, and the British Society of Echocardiography Clinical Standards and Departmental Accreditation Committees
David Oxborough, Saqib Ghani, Allan Harkness, Guy Lloyd, William Moody, Liam Ring, Julie Sandoval, Roxy Senior, Nabeel Sheikh, Martin Stout, Victor Utomi, James Willis, Abbas Zaidi, and Richard Steeds
The aim of the study is to establish the impact of 2D echocardiographic methods on absolute values for aortic root dimensions and to describe any allometric relationship to body size. We adopted a nationwide cross-sectional prospective multicentre design using images obtained from studies utilising control groups or where specific normality was being assessed. A total of 248 participants were enrolled with no history of cardiovascular disease, diabetes, hypertension or abnormal findings on echocardiography. Aortic root dimensions were measured at the annulus, the sinus of Valsalva, the sinotubular junction, the proximal ascending aorta and the aortic arch using the inner edge and leading edge methods in both diastole and systole by 2D echocardiography. All dimensions were scaled allometrically to body surface area (BSA), height and pulmonary artery diameter. For all parameters with the exception of the aortic annulus, dimensions were significantly larger in systole (P<0.05). All aortic root and arch measurements were significantly larger when measured using the leading edge method compared with the inner edge method (P<0.05). Allometric scaling provided a b exponent of BSA0.6 in order to achieve size independence. Similarly, ratio scaling to height in subjects under the age of 40 years also produced size independence. In conclusion, the largest aortic dimensions occur in systole while using the leading edge method. Reproducibility of measurement, however, is better when assessing aortic dimensions in diastole. There is an allometric relationship to BSA and, therefore, allometric scaling in the order of BSA0.6 provides a size-independent index that is not influenced by the age or gender.
Mohammad Qasem, Victor Utomi, Keith George, John Somauroo, Abbas Zaidi, Lynsey Forsythe, Sanjeev Bhattacharrya, Guy Lloyd, Bushra Rana, Liam Ring, Shaun Robinson, Roxy Senior, Nabeel Sheikh, Mushemi Sitali, Julie Sandoval, Richard Steeds, Martin Stout, James Willis, and David Oxborough
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited pathology that can increase the risk of sudden death. Current task force criteria for echocardiographic diagnosis do not include new, regional assessment tools which may be relevant in a phenotypically diverse disease. We adopted a systematic review and meta-analysis approach to highlight echocardiographic indices that differentiated ARVC patients and healthy controls.
Data was extracted and analysed from prospective trials that employed a case–control design meeting strict inclusion and exclusion as well as a priori quality criteria. Structural indices included proximal RV outflow tract (RVOT1) and RV diastolic area (RVDarea). Functional indices included RV fractional area change (RVFAC), tricuspid annular systolic excursion (TAPSE), peak systolic and early diastolic myocardial velocities (S′ and E′, respectively) and myocardial strain.
Patients with ARVC had larger RVOT1 (mean ± s.d.; 34 vs 28 mm, P < 0.001) and RVDarea (23 vs 18 cm2, P < 0.001) compared with healthy controls. ARVC patients also had lower RVFAC (38 vs 46%, P < 0.001), TAPSE (17 vs 23 mm, P < 0.001), S′ (9 vs 12 cm/s, P < 0.001), E′ (9 vs 13 cm/s, P < 0.001) and myocardial strain (−17 vs −30%, P < 0.001).
The data from this meta-analysis support current task force criteria for the diagnosis of ARVC. In addition, other RV measures that reflect the complex geometry and function in ARVC clearly differentiated between ARVC and healthy controls and may provide additional diagnostic and management value. We recommend that future working groups consider this data when proposing new/revised criteria for the echocardiographic diagnosis of ARVC.
Martin R Cowie
diagnosis of heart failure – being the most readily available and economic manner of imaging the heart and gathering key information about its structure and function. NHS audit data We are fortunate in the United Kingdom to have a national audit of
. Quantitative measurements have no available reference standard in day-to-day clinical practice, limiting the usefulness and applicability of intra- and inter-observer variability assessments. Since these audit and QA exercises are difficult and time consuming
Toby C Thomas and Claire L Colebourn
-quality healthcare is a hard task master. It requires us to define and regulate every stage of clinical processes through a continuous cycle of reflection and correction. Audit is a key example of cyclical reflective practice, and it was identified by Lord Francis in
Brian Campbell, Shaun Robinson, and Bushra Rana
posts held Current role Clinical responsibilities Teaching and education Management Course/conferences attended Research/audit Service development and improvement Professional practice Professional practice relates to a wide
Sarah Ritzmann, Stephanie Baker, Marcus Peck, Tom E Ingram, Jane Allen, Laura Duffy, Richard P Steeds, Andrew Houghton, Andrew Elkington, Nina Bual, Robert Huggett, Keith Pearce, Stavros Apostolakis, Khalatabari Afshin, and the British Society of Echocardiography Departmental Accreditation and Clinical Standards Committees with input from the Intensive Care Society
reviewing requests and reports, audit, quality control, protocols for imaging, and urgent clinical review in response to findings at echocardiography. 1.4. The healthcare scientist lead must hold individual BSE accreditation (or equivalent) and be graded
Victoria Pettemerides, Thomas Turner, Conor Steele, and Anita Macnab
target heart rate for the exercise stress echo group and at baseline, low dose, intermediate and target heart rate in the dobutamine group. Images were interpreted by an experienced imaging consultant. Follow-up The audit was considered part of
Sanjeev Bhattacharyya, Denise Parkin, and Keith Pearce
competencies is advised prior starting as a valve clinic practitioner. This may take the form of a review of the prospective valve practitioner’s clinical assessment and proposed management plans for a set number of patients. Audit and research