The structural heart disease interventional imager rationale, skills and training: a position paper of the European Association of Cardiovascular Imaging.
[en] Percutaneous therapeutic options for an increasing variety of structural heart diseases (SHD) have grown dramatically. Within this context of continuous expansion of devices and procedures, there has been increased demand for physicians with specific knowledge, skills, and advanced training in multimodality cardiac imaging. As a consequence, a new subspecialty of 'Interventional Imaging' for SHD interventions and a new dedicated professional figure, the 'Interventional Imager' with specific competencies has emerged. The interventional imager is an integral part of the heart team and plays a central role in decision-making throughout the patient pathway, including the appropriateness and feasibility of a procedure, pre-procedural planning, intra-procedural guidance, and post-procedural follow-up. However, inherent challenges exist to develop a training programme for SHD imaging that differs from traditional cardiovascular imaging pathways. The purpose of this document is to provide the standard requirements for the training in SHD imaging, as well as a starting point for an official certification process for SHD interventional imager.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Agricola, Eustachio; Cardiovascular Imaging Unit, San Raffaele Hospital, IRCCS, Vita-Salute San
Ancona, Francesco; Cardiovascular Imaging Unit, San Raffaele Hospital, Milan, Italy.
Brochet, Eric; Cardiology Department, Hôpital BICHAT Paris, France.
Donal, Erwan; Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes-1, Rennes,
Dweck, Marc; Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Faletra, Francesco; Director of cardiac imaging service, . Cardiocentro Ticino Switzerland.
LANCELLOTTI, Patrizio ; Centre Hospitalier Universitaire de Liège - CHU > > Service de cardiologie ; Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and
Mahmoud-Elsayed, Hani; Consultant Cardiologist, Director of Echocardiography Lab, Al-Nas Hospital,
Marsan, Nina Ajmone; Department of Cardiology, Leiden University Medical Center, The Netherlands.
Maurovich-Hovart, Pal; Medical Imaging Centre, Semmelweis University, Budapest, Hungary.
Monaghan, Mark; Director of Non-Invasive Cardiology, King's College Hospital, London, UK.
Ribeiro, José; Thorax and Circulation Unit Director, Gaia Hospital Center, Oporto, Portugal.
Sade, Leyla Elif; University of Baskent, Department of Cardiology, Ankara, Turkey.
Swaans, Martin; Department of Cardiology, St.Antonius Hospital, Nieuwegein, The Netherlands.
Von Bardeleben, Ralph Stephan; Dep. of Cardiology I, Heart Valve Center, Universitätsmedizin Mainz, Mainz,
Wunderlich, Nina; Cardiovascular Center Darmstadt, Darmstadt, Germany.
Zamorano, Jose-Luis; University Hospital Ramon y Cajal, Madrid, Spain.
Popescu, Bogdan A; Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila' -
Cosyns, Bernard; Cardiology Department, Centrum voor Hart en Vaatziekten (CHVZ), Universitair
Edvardsen, Thor; Dept of Cardiology, Oslo University Hospital, Pb 4950 Nydalen, 0424, Oslo, ; Faculty of Medicine, University of Oslo, Oslo, Norway.
Reviewers: This document was reviewed by members of the 2018-2020 EACVI
The structural heart disease interventional imager rationale, skills and training: a position paper of the European Association of Cardiovascular Imaging.
Hahn RT, Mahmood F, Kodali S, Lang R, Monaghan M, Gillam LD et al. Core competencies in echocardiography for imaging structural heart disease interventions. JACC Cardiovasc Imaging 2019;12:2560-70.
Grapsa J, Kunadian V, Capodanno D, Vidal-Perez R, Radu M, Christia P et al. Joint EACVI HIT/EAPCI young survey/ESC CoT survey: training and education for 'multimodality imaging in structural interventions': the rise of a new sub-specialty? Eur Heart J Cardiovasc Imaging 2016;17:1432-3.
Swaminathan M. Steve jobs and the value of interventional imagers. J Am Soc Echocardiogr 2019;32:A17-8.
Faza NN, Toko MD, Hahn, RT. Imaging in structural heart disease. The evolution of a new subspecialty. J Am Coll Cardiol Case Rep 2019;1:440-5.
Wang DD, Geske J, Choi AD, Khalique O, Lee J, Atianzar K et al. Navigating a career in structural heart disease interventional imaging. JACC Cardiovasc Imaging 2018;11:1928-30.
Salaun E, Carles S, Bigand E, Pankert M, Aldebert P, Jaussaud N et al. High radiation exposure of the imaging specialist during structural heart interventions with echocardiographic guidance. JACC Cardiovasc Interv 2017;10:626-7.
Crowhurst JA, Scalia GM, Whitby M, Murdoch D, Robinson BJ, Turner A et al. Radiation exposure of operators performing transesophageal echocardiography during percutaneous structural cardiac interventions. J Am Coll Cardiol 2018;71: 1246-54.
Hirshfeld JW Jr, Ferrari VA, Bengel FM, Bergersen L, Chambers CE, Einstein AJ et al. 2018 ACC/HRS/NASCI/SCAI/SCCT expert consensus document on optimal use of ionizing radiation in cardiovascular imaging: best practices for safety and effectiveness: a report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol 2018;71:2829-55.
Raphael CE, Alkhouli M, Maor E, Panaich SS, Alli O, Coylewright M et al. Building blocks of structural intervention: a novel modular paradigm for procedural training. Circ Cardiovasc Interv 2017;10:e005686.
Cavalcante JL, Wang DD. Structural heart interventional imagers-the new face of cardiac imaging. Arq Bras Cardiol 2018;111:645-7.
Speidel MA. Inverse geometry x-ray imaging: application in interventional procedures. J Am Coll Radiol 2011;8:74-7.
Faletra FF, Ramamurthi A, Dequarti MC, Leo LA, Moccetti T, Pandian N. Artifacts in three-dimensional transesophageal echocardiography. J Am Soc Echocardiogr 2014;27:453-62.
Alkhouli M, Hijazi ZM, Holmes DR Jr, Rihal CS, Wiegers SE. Intracardiac echocardiography in structural heart disease interventions. JACC Cardiovasc Interv 2018;11:2133-47.
Bartel T, Muller S, Biviano A, Hahn RT. Why is intracardiac echocardiography helpful? Benefits, costs, and how to learn. Eur Heart J 2014;35:69-76.
Alqahtani F, Bhirud A, Aljohani S, Mills J, Kawsara A, Runkana A et al. Intracardiac versus transesophageal echocardiography to guide transcatheter closure of interatrial communications: nationwide trend and comparative analysis. J Interven Cardiol 2017;30:234-41.
Kavinsky CJ, Poulin MF, Mack MJ. Training in structural heart disease: call to action. Circulation 2018;138:225-8.
Steinberg DH, Staubach S, Franke J, Sievert H. Defining structural heart disease in the adult patient: current scope, inherent challenges and future directions. Eur Heart J Suppl 2010;12:E2-9.
Tanner FC, Brooks N, Fox KF, Gonçalves L, Kearney P, Michalis L et al. ESC core curriculum for the cardiologist. Eur Heart J 2020;41:3605-92. doi: 10.1093/ eurheartj/ehaa641.
Popescu BA, Stefanidis A, Fox KF, Cosyns B, Delgado V, Di Salvo G et al. Training, competence, and quality improvement in echocardiography: the European Association of Cardiovascular Imaging recommendations. Eur Hear J - Cardiovasc Imaging 2020;21:1305-19.
Pontone G, Moharem-Elgamal S, Maurovich-Horvat P, Gaemperli O, Pugliese F, Westwood M, Document reviewers et al. Training in cardiac computed tomography: EACVI certification process. Eur Hear J - Cardiovasc Imaging 2018;19: 123-6.