competence; echocardiography; quality; recommendations; training
Abstract :
[en] The primary mission of the European Association of Cardiovascular Imaging (EACVI) is 'to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging'. Echocardiography is a key component in the evaluation of patients with known or suspected cardiovascular disease and is essential for the high quality and effective practice of clinical cardiology. The EACVI aims to update the previously published recommendations for training, competence, and quality improvement in echocardiography since these activities are increasingly recognized by patients, physicians, and payers. The purpose of this document is to provide the general requirements for training and competence in echocardiography, to outline the principles of quality evaluation, and to recommend a set of measures for improvement, with the ultimate goal of raising the standards of echocardiographic practice. Moreover, the document aims to provide specific guidance for advanced echo techniques, which have dramatically evolved since the previous publication in 2009.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Popescu, Bogdan A.
Stefanidis, Alexandros
Fox, Kevin F.
Cosyns, Bernard
Delgado, Victoria
Di Salvo, Giovanni Di
Donal, Erwan
Flachskampf, Frank A.
Galderisi, Maurizio
Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Popescu BA, Andrade MJ, Badano LP, Fox KF, Flachskampf FA, Lancellotti P et al.; on behalf of the European Association of Echocardiography. European Association of Echocardiography recommendations for training, competence, and quality improvement in echocardiography. Eur J Echocardiogr 2009;10:893–905.
Papolos A, Narula J, Bavishi C, Chaudhry F, Sengupta P. U.S. Hospital use of echocardiography. Insights from the nationwide inpatient sample. J Am Coll Cardiol 2016;67:502–11.
Medlej K, Lewiss R. I’m an Emergency medicine resident with a special interest in ultrasonography: should I take a certification examination? Ann Emerg Med 2011; 58:490–3.
Shah B, Lindsay A, Nicol E. What is the role of accreditation in the era of competency-based specialist training. A perspective from the United Kingdom. Int J Cardiol 2012;160:79–81.
Tanner F, Brooks N, Fox K, Gonçalves L, Kearney P, Michalis L, et al. ESC Core Curriculum for tCardiologist. Eur Heart J 2020;00:1-88 doi:10.1093/eurheartj/ ehaa641
Echo Core Syllabus. A learning framework for continuous medical education in cardiovascular imaging. https://www.escardio.org/Education/Echo-CoreSyllabus(4 October 2020, date last accessed).
Gillebert T, Brooks N, Fontes-Carvalho R, Fras Z, Gueret P, Lopez-Sendon J et al.; European Society of Cardiology. ESC Core Curriculum for the General Cardiologist (2013) European Society of Cardiology Committee for Education. Eur Heart J 2013;34:2381–411.
Ryan T, Berlacher K, Lindner J, Mankad S, Rose G, Wang A. COCATS 4 Task Force 5: training in echocardiography. J Am Soc Echocardiogr 2015;28:615–27.
Wiegers S, Ryan T, Arrighi J, Brown S, Canaday B, Damp J et al. 2019 ACC/ AHA/ASE Advanced Training Statement on Echocardiography (Revision of the 2003 ACC/AHA Clinical Competence Statement on Echocardiography). A report of the ACC Competency Management Committee. J Am Soc Echocardiogr 2019;32:919–43.
https://www.bsecho.org/Public/Accreditation/Personal-accreditation/Process/Public/Accreditation/Accreditation-subpages/Personal-accreditation-subpages/ Process.aspx?hkey=512f4124-0dd2-4dc4-a7b0-c661fed3cde0 (4 October 2020, date last accessed).
Quinones MA, Douglas PS, Foster E, Gorcsan J III, Lewis JF, Pearlman AS et al. ACC/AHA clinical competence statement on echocardiography: a report of the American College of Cardiology/American Heart Association/American College of Physicians–American Society of Internal Medicine Task Force on Clinical Competence. J Am Coll Cardiol 2003;41:687–708.
https://www.escardio.org/Education/Career-Development/Certification/EACVICertification-Accreditation (29 May 2020, date last accessed).
Daniel W, Erbel R, Kasper W, Visser C, Engberding R, Sutherland G et al. Safety of transesophageal echocardiography. Circulation 1991;83:817–21.
Evangelista A, Flachskampf F, Lancellotti P, Badano L, Aguilar R, Monaghan M et al.; on behalf of the European Association of Echocardiography. European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr 2008;9:438–48.
Popescu BA, Stefanidis A, Nihoyannopoulos P, Fox K, Ray S, Cardim N et al. Updated standards and processes for accreditation of echocardiographic laboratories from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2014;15:717–27.
Douglas PS, Khandheria B, Stainback RF, Weissman NJ, Brindis RG, Patel MR et al. ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American Society of Echocardiography, American College of Emergency Physicians, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance endorsed by the American College of Chest Physicians and the Society of Critical Care Medicine. J Am Coll Cardiol 2007;50:187–204.
Steeds RP, Garbi M, Cardim N, Kasprzak JD, Sade E, Nihoyannopoulos P et al. EACVI appropriateness criteria for the use of transthoracic echocardiography in adults: a report of literature and current practice review. Eur Heart J Cardiovasc Imaging 2017;18:1191–204.
Flachskampf FA, Wouters PF, Edvardsen T, Evangelista A, Habib G, Hoffman P et al. Recommendations for transoesophageal echocardiography: EACVI update 2014. Eur Heart J Cardiovasc Imaging 2014;15:353–65.
http://learn.escardio.org/dashboard/trainer/local (4 October 2020, date last accessed).
Ferrero NA, Bortsov AV, Arora H, Martinelli SM, Kolarczyk LM, Teeter EC et al. Simulator training enhances resident performance in transesophageal echocardiography. Anesthesiology 2014;120:149–59.
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015;16:233–70.
Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2014;15:1063–93.
Zamorano J, Goncalves A, Lancellotti P, Andersen KA, Gonzalez-Gomez A, Monaghan M et al. The use of imaging in new transcatheter interventions: an EACVI review paper. Eur Heart J Cardiovasc Imaging 2016;17:835.
Lancellotti P, Tribouilloy C, Hagendorff A, Popescu BA, Edvardsen T, Pierard LA et al.; On behalf of the Scientific Document Committee of the European Association of Cardiovascular Imaging. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2013;14:611–44.
Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T et al. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging 2012;13:1–46.
Narang A, Lang RM, Addetia K. 3D echocardiography and level III training. J Am Coll Cardiol Imaging 2016;9:1017–8.
Hahn R, Mahmood F, Kodali S, Lang R, Monaghan M, Gillam L et al. Core competencies in echocardiography for imaging structural heart disease interventions. An Expert Consensus Statement. J Am Coll Cardiol Imaging 2019;12:2560–70.
Sicari R, Nihoyannopoulos P, Evangelista A, Kasprzak J, Lancellotti P, Poldermans D et al.; on behalf of the European Association of Echocardiography. Stress echocardiography expert consensus statement: European Association of Echocardiography. Eur J Echocardiogr 2008;9:415–37.
Picano E, Lattanzi F, Orlandini A, Marini C, L’Abbate A. Stress echocardiography and the human factor: the importance of being expert. J Am Coll Cardiol 1991;24: 928–33.
Imran MB, Palinkas A, Pasanisi EM, De Nes M, Picano E. Optimal reading criteria in stress echocardiography. Am J Cardiol 2002;90:444–5.
Pellikka PA, Nagueh SF, Elhendy AA, Kuehl CA, Sawada SG. American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr 2007;20:1021–41.
Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R et al. The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations of the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2016;17: 1191–229.
Becher H, Chambers J, Fox K, Jones R, Leech GJ, Masani N et al. BSE procedure guidelines for the clinical application of stress echocardiography, recommendations for performance and interpretation of stress echocardiography: a report of the British Society of Echocardiography Policy Committee. Heart 2004;90: vi23–30.
Senior R, Becher H, Monaghan M, Agati L, Zamorano J, Vanoverschelde JL et al. Clinical practice of contrast echocardiography: recommendation by the European Association of Cardiovascular Imaging 2017. Eur Heart J Cardiovasc Imaging 2017;18:1205.
Di Salvo G, Miller O, Babu Narayan S, Li W, Budts W, Valsangiacomo Buechel ER et al.; the 2016–2018 EACVI Scientific Documents Committee. 2016–2018 EACVI Scientific Documents Committee. Imaging the adult with congenital heart disease: a multimodality imaging approach-position paper from the EACVI. Eur Heart J Cardiovasc Imaging 2018;19:1077–98.
Babu-Narayan SV, Giannakoulas G, Valente AM, Li W, Gatzoulis MA. Imaging of congenital heart disease in adults. Eur Heart J 2016;37:1182–95.
Potter E, Marwick TW. Assessment of left ventricular function by echocardiography: the case for routinely adding global longitudinal strain to ejection fraction. J Am Coll Cardiol Imaging 2018;11:260–74.
Negishi T, Negishi K, Thavendiranathan P, Cho GY, Popescu BA, Vinereanu D et al.; on behalf of the SUCCOUR Investigators. Effect of experience and training on the concordance and precision of strain measurements. J Am Coll Cardiol Imaging 2017;10:518–22.
Badano LP, Kolias TJ, Muraru D, Abraham TP, Aurigemma G, Edvardsen T et al.; Industry Representatives. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 2018;19:591–600.
Neskovic A, Skinner H, Price S, Via G, De Hert S, Stankovic I et al. Focus cardiac ultrasound core curriculum and core syllabus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2018;19:475–81.
Neskovic A, Edvardsen T, Galderisi M, Garbi M, Gullace G, Jurcut R et al.; for the European Association of Cardiovascular Imaging Document Reviewers. Focus cardiac ultrasound: the European Association of Cardiovascular Imaging viewpoint. Eur Heart J Cardiovasc Imaging 2014;15:956–60.
Fox K, Achenbach S, Bax J, Cosyns B, Delgado V, Dweck MR et al. Multimodality imaging in cardiology: a statement on behalf of the Task Force on Multimodality Imaging of the European Association of Cardiovascular Imaging. Eur Heart J 2019; 40:553–8.
Narula J, Chandrashekhar YS, Dilsizian V, Garcia MJ, Kramer CM, Malik S et al. COCATS 4 Task Force 4: training in multimodality imaging. J Am Coll Cardiol 2015;65:1778–85.
Picard MH, Adams D, Bierig SM, Dent JM, Douglas PS, Gillam LD et al. American Society of Echocardiography recommendations for quality echocardiography laboratory operations. J Am Soc Echocardiogr 2011;24:1–10.
Lopez-Sendon J, Mills P, Weber H, Michels R, Di Mario C, Filippatos GS et al.; Authors/Task Force Members. Recommendations on sub-speciality accreditation in cardiology: the Coordination Task Force on Sub-speciality Accreditation of the European Board for the Speciality of Cardiology. Eur Heart J 2007;28:2163–71.
Fox KF, Flachskampf F, Zamorano JL, Badano L, Fraser AG, Pinto FJ. Report on the first written exam held as part of the European Association of Echocardiography Accreditation Process in Adult Transthoracic Echocardiography. Eur J Echocardiogr 2004;5:320–5.
Fox KF, Popescu BA, Janiszewski S, Nihoyannopoulos P, Fraser AG, Pinto FJ. Report on the European Association of Echocardiography Accreditations in Echocardiography: December 2003 to September 2006. Eur J Echocardiogr 2007; 8:74–9.
https://www.escardio.org/Education/Career-Development/Certification/EACVIrecertification(4 October 2020, date last accessed).
Fonseca R, Negishi K, Otahal P, Marwick TH. Temporal changes in appropriateness of cardiac imaging. J Am Coll Cardiol 2015;65:763–73.
Galderisi M, Cosyns B, Edvardsen T, Cardim N, Delgado V, Di Salvo G et al. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2017;18:1301–10.
Bhattacharyya S, James R, Rimington H, Allen J, Lee L, Fox K et al.; on behalf of the British Society of Echocardiography. Development of a national echocardiography quality improvement programme: insights into feasibility, uptake, and clinical utility. Eur Heart J Cardiovasc Imaging 2014;15:747–52.
Fox KF. The evaluation of left ventricular function for patients being considered for or receiving Trastuzumab (Herceptin) therapy. Br J Cancer 2006; 95:1454.
Johri AM, Picard MH, Newell J, Marshall JE, King ME, Hung J. Can a teaching intervention reduce interobserver variability in LVEF assessment: a quality control exercise in the echocardiography lab. J Am Coll Cardiol Imaging 2011;4:821–9.
Thavendiranathan P, Popovic ZB, Flamm SD, Dahiya A, Grimm RA, Marwick TH. Improved interobserver variability and accuracy of echocardiographic visual left ventricular ejection fraction assessment through a self-directed learning program using cardiac magnetic resonance images. J Am Soc Echocardiogr 2013;26: 1267–73.
Daubert MA, Yow E, Barnhart HX, Rabineau D, Crowley AL, Douglas P. Quality improvement implementation: improving reproducibility in the echocardiography laboratory. J Am Soc Echocardiogr 2015;28:959–68.
Heidenreich PA, Maddox TM, Nath J. Measuring the quality of echocardiography using the predictive value of the left ventricular ejection fraction. J Am Soc Echocardiogr 2013;26:237–42.
Ling LF, Obuchowski NA, Rodriguez L, Popovic Z, Kwon D, Marwick TH. Accuracy and interobserver concordance of echocardiographic assessment of right ventricular size and systolic function: a quality control exercise. J Am Soc Echocardiogr 2012;25:709–13.
Lang R, Addetia K, Narang K, Mor-Avi V. 3-Dimensional echocardiography. Latest developments and future directions. J Am Coll Cardiol Imaging 2018;11: 1855–1878.
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016;17:1321–60.
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 2008;10:165–93.
Nagueh S, Abraham T, Aurigemma G, Bax J, Beladan C, Browning A et al.; for Diastolic Function Assessment Collaborators. Interobserver variability in applying American Society of Echocardiography/European Association of Cardiovascular Imaging 2016 guidelines for estimation of left ventricular filling pressure circulation. Cardiovasc Imaging 2019;12:e008122.
Edvardsen T, Smiseth O. Evaluation of diastolic function by echocardiography: important progression, but issues to be resolved. Eur Heart J Cardiovasc Imaging 2018;19:387–388.
Almeida JG, Fontes-Carvalho R, Sampaio F, Ribeiro J, Bettencourt P, Flachskampf FA et al. Impact of the 2016 ASE/EACVI recommendations on the prevalence of diastolic dysfunction in the general population. Eur Heart J Cardiovasc Imaging 2018;19:380–386.
Eskandari M, Kramer C, Hecht H, Jaber W, Marwick T. Evidence base for quality control activities in cardiovascular imaging. J Am Coll Cardiol Imaging 2016;9: 294–305.
