The best of 2005 in echocardiography back from EuroEcho 9 – Florence, Italy
© Sicari; licensee BioMed Central Ltd. 2006
Received: 05 January 2006
Accepted: 15 February 2006
Published: 15 February 2006
The ninth edition of the congress of the European Association of Echocardiography (EAE) (former working group of Echocardiography) held in Florence has just finished with a great success of participant attendance (2.842) and abstract submissions. Hot topics at EuroEcho 9 were: 1-live 3-dimensional echocardiography and surgical decision making; in pediatric cardiology; in resynchronization therapy 2- stress echocardiography beyond wall motion: from valve diseases to contractility to coronary flow reserve to diastolic function; 3- pulmonary cardiogenic interstitial thickening recognized by ultrasonic lung comets; 4- the "proven clinical inefficacy" of the many technologies sold as breakthrough: color kinesis, tissue characterization, strain rate, tissue Doppler, applied to stress echocardiography.
The Meeting of the European Association of Echocardiography (EuroEcho9) that took place in Florence from December 6th to 10th, has just finished achieving the record of abstract submissions and participant attendance (2.842). The interest on ultrasound technologies is very high and is still increasing over time in relation to its widespread employment, often outside the cardiological community. This is a brief report on what went on for those who could not attend the meeting or could not follow all the sessions.
During the opening ceremony, the president Alan Fraser announced the result of the recent elections for a new member in the Board. The winner was Prof. Albert Varga from Szeged, Hungary. He has an outstanding curriculum characterized by some key publications on safety of stress echocardiography and evaluating new protocols for the detection of myocardial viability. His election is very welcome inside the Board since he represents an independent and highly appreciated voice of the new European Union countries. For the first time the Association employed a completely electronic voting system (different from the previous one that was conducted via e-mail). The electoral system employed by the Association allows that any echocardiographist from any associated country member (the membership of countries to the European Association does not correspond to the 25 members of the European Union but is much larger), can submit his/her resume to the Board. The candidatures do not go through a selection system unless more than five candidates apply for the same position, as stated in the bylaws of the Association. In that particular case the Board will select the best profiles that would fit for that position. The electronic vote posed some technical problems (many physicians found the access a little bit too complicated) but the time allowed for voting was long enough to overcome these limitations. This is an open and transparent way to have access to the Board independent of country of origin and power of the echo working groups. In fact, if it is true that the two societies with the largest number of members in Europe (Italy and Poland) do have three members each in the Board, it is also true that much smaller working groups were able to elect their representatives such as Romania or Hungary. In the near future a new election for two critical positions, secretary of the Association and President will be held. It would be advisable that the endorsement of the national working groups and/or societies for candidatures were optional and not mandatory: the need for the support of national societies might exclude those who do not lead an active political life in their home societies but nonetheless can represent large sections of the European scientific community on the basis of their curriculum. This problem might be overcome with the institution of a co-membership fee that would make all the national working groups constituent bodies of EAE.
The making of imaging guidelines
During the ceremony it was announced with great emphasis the imminent submission to the European Heart Journal of a position paper on the future of non-invasive imaging modalities in cardiovascular diagnosis. The joint statement will be signed by Alan Fraser and Petros Nihoyannopoulos on behalf of the EAE, Peter Buser and Jürg Schwitter on behalf of the Working Group on Cardiovascular Magnetic Resonance, Jeroen Bax and Juhani Knuuti on behalf of the Working Group on Nuclear Cardiology; Radiology Associations were invited to join among the authors in order to have a widespread acceptance, of general criteria to be applied every time an imaging technique is employed in the clinical practice. The first draft made available to the members of the Board of EAE raised many questions with an overwhelming feeling of not having taken any position regarding imaging modalities. The general view stems from the idea that all the techniques were created equal and can be used in the same clinical setting provided that they are non-invasive and performed by cardiologists. In fact, "no competition among modalities" is the key phrase of the paper. Too little to provide clearer indications to a cardiological community that is pressured between marketing forces giving birth to the latest high-tech indispensable machine and a scientific community unable to speak up sound and loud on the many conceivable limitations and risks of imaging techniques. The aim of the paper should be to create the intellectual and political framework to move from the culture of waste to the culture of responsibility and safety, in which the only possible competition of imaging modalities should be run on the basis of their cost-effectiveness, biological risks, safety, with the ultimate scope of providing key clinical and additive information to the patient .Nonetheless, authors promised to amend the manuscript on the basis of the criticism that was made. Those who have the responsibility of setting the pace (writing statements and/or guidelines) should take into consideration not only their personal view but also patient's needs and the impact of potentially wrong or neutral recommendations that will influence clinical practice . I am sure that all these aspects will become the standard practice in the clinical evaluation of an imaging modality.
Hot topics in scientific sessions
The Accreditation process
Accreditation in echocardiography has become a very important activity for the Association and the success of the exams, this year also in transesophageal echocardiography in association with European Association of Cardiothoracic Anaesthesiologists (EACTA), is measured by the increasing number of echocardiographists attending the theoretical part. In Florence 31 out of 48 echocardiographists passed the theoretical part of the TTE exam and 37 out 45 of the TEE exam. Kevin Fox and Bogdan Popescu are the masterminds behind this honorable activity. The presence of Luc Mertens inside the Board of EAE as a non-voting member brought clear advantages to the Association such as the first exam in accreditation in congenital heart disease that will be held in Prague, on December 2006, during EuroEcho 10 in association with the European Association for Pediatric Cardiologist (AEPC) and Grown-Up Congenital Heart Disease working group (GUCH). It would be advisable that the National societies and/or working groups recognized the European accreditation exam in order to avoid two parallel processes with different criteria and procedures.
A proposal for EuroEcho 10
What is missing from the general picture of European echocardiography? The words of Richard Feynman, the physics Nobel Prize, are of help: what is missing is the "perfectly reasonable deviations from the beaten track" . What is the reason for having ten sessions on contrast and no session on contractility? Not to have more pathophysiologic and experimental research performed by ultrasounds? More open discussions on controversial issues that have become standards without passing through scientific validation? [13, 14] (Doppler velocities etc. By the way the guidelines on tissue Doppler imaging are under revision).
We should give the echocardiographic scientific and clinical community clear positions and some more "eccentric" (non mainstream) research. Let's keep in mind the warning of Bernard Lown: "Technology in medicine is frequently untested scientifically, often applied without data relating to cost benefit, and driven by market forces rather than by patient needs" . It should be our aim to try to revert this trend.
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