Stress echocardiography in Italian echocardiographic laboratories: A survey of the Italian society of echocardiography and cardiovascular imaging

Background: The Italian Society of Echography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand the volumes of activity, modalities and stressors used during stress echocardiography (SE) in Italy. Methods: We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved through an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results: Data were obtained from 228 echocardiographic laboratories, and SE examinations were performed in 179 centers (80.6%): 87 centers (47.5%) were in the northern regions of Italy, 33 centers (18.4%) were in the central regions, and 61 (34.1%) in the southern regions. We annotated a total of 4057 SE. We divided the SE centers into three groups, according to the numbers of SE performed: <10 SE (low-volume activity, 40 centers), between 10 and 39 SE (moderate volume activity, 102 centers) and >= 40 SE (high volume activity, 37 centers). Dipyridamole was used in 139 centers (77.6%); exercise in 120 centers (67.0%); dobutamine in 153 centers (85.4%); pacing in 37 centers (21.1%); and adenosine in 7 centers (4.0%). We found a significant difference between the stressors used and volume of activity of the centers, with a progressive increase in the prevalence of number of stressors from low to high volume activity (P = 0.033). The traditional evaluation of regional wall motion of the left ventricle was performed in all centers, with combined assessment of coronary flow velocity reserve (CFVR) in 90 centers (50.3%): there was a significant difference in the centers with different volume of SE activity: the incidence of analysis of CFVR was significantly higher in high volume centers compared to low - moderate - volume (32.5%, 41.0% and 73.0%, respectively, P < 0.001). The lung ultrasound (LUS) was assessed in 67 centers (37.4%). Furthermore for LUS, we found a significant difference in the centers with different volume of SE activity: significantly higher in high volume centers compared to low - moderate - volume (25.0%, 35.3% and 56.8%, respectively, P < 0.001). Conclusions: This nationwide survey demonstrated that SE was significantly widespread and practiced throughout Italy. In addition to the traditional indication to coronary artery disease based on regional wall motion analysis, other indications are emerging with an increase in the use of LUS and CFVR, especially in high-volume centers

Early detection with speckle tracking echocardiography of biventricular systolic dysfunction, and its relationship with fatigue, in patients with multiple sclerosis

Abstract Funding Acknowledgements Type of funding sources: None. Background Fatigue is a frequent and debilitating symptom of multiple sclerosis (MS), affecting 90% of patients. Symptoms seems multifactorial, but little is known about the contribution of cardiovascular morpho-functional alterations linked to comorbidities, to lifestyle, to MS itself or to drugs (i.e. mitoxantrone). Aim to investigate the presence of cardiac alterations in MS patients, and to evaluate their impact on fatigue. Methods  24 patients with relapsing-remitting MS (RR-MS) underwent an electrocardiogram (ECG), a transthoracic echocardiographic (TTE), a six minutes walking test (6MWT) with Borg scale (BS), and two fatigue self-assessment scales, the Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS). The patients were divided into 2 groups: group 1, without traditional cardiovascular risk factors (CVRF: smoke, hypertension, diabetes, hypercholesterolemia; n = 12, 11 females), and group 2, with at least one CVRF (n = 12, 5 females). None of the patients had ever been on mitoxantrone therapy. No new control group was studied due to the SARS-CoV-2 pandemic restrictions , so the comparison was performed with general healthy population in internationally validated previous studies. Results No arrhythmias were found. In both MS groups all the TTE left ventricular (LV) systolic function parameters were depressed compared to the healthy population, but only the mean global longitudinal strain (GLS), the mean longitudinal strain rate (LSR) of LV and estimated pulmonary artery systolic pressure (PAPs) were statistically significant depressed compared to the healthy general population (p &amp;lt; 0.005): see table. This reduction was observed in both MS groups, while there were non significant differences among the two groups. TTE LV function depression significantly correlated to variation of parameters of fatigue , especially considering LV GLS in relation to BS values. Conclusions Subclinical biventricular systolic dysfunction is present in MS patients, and it seems to be linked to the disease itself without being influenced by CVRF. This dysfunction, detected by speckle tracking echocardiographic techniques, seems to contribute to the symptom of fatigue in patients with MS. It is important to include TTE in the workup and follow-up of MS patients, in order to promptly treat cardiac dysfunction and relieve fatigue. Echocardiography and LV strain MS total MS no CVRF MS + CVRF Healthy population LV GLS 17.7 ± 2.2* 18.0 ± 2.1* 17.4 ± 2.4* 22.6 ± 1.7 LV LSR 1.0 ± 0.1* 1.0 ± 0.1* 1.0 ± 0.2* 1.2 ± 0.1 PAPs 25.0 ± 2.6* 24.8 ± 2.9* 25.2 ± 2.5* 14.0 ± 6.0 * p &amp;lt; 0.05 vs healthy population </jats:sec

Aspectos históricos, culturais e sociais do trabalho Aspectos historicos, culturales y sociales del trabajo Historical, cultural and social aspects of labor

Trata-se de um estudo histórico-social que teve como objetivo contribuir para a compreensão da contínua evolução do processo de trabalho e sua íntima relação com o trabalhador. Foram utilizadas para a elaboração deste ensaio fontes bibliográficas diversas, com fundamento em dados históricos, conceituais, filosóficos e científicos. Os achados nos levaram à conclusão que, embora profundas transformações tenham ocorrido no mundo do trabalho, em sua essência, a atividade laboriosa marcou a vida dos indivíduos e das coletividades em diferentes épocas e lugares.<br>Es un estudio histórico-social, cuyo objetivo fue contribuir para la comprensión de la continua evolución del proceso de trabajo, desde la Antigüedad Clásica hasta la industrialización en el mundo moderno, y su íntima relación con el trabajador. Fueron utilizadas para la elaboración de este ensayo fuentes bibliográficas diversas, fundamentadas en datos históricos, conceptuales, filosóficos y científicos. Lo observado nos permite concluir que, aunque profundas transformaciones hayan ocurrido en el mundo del trabajo, en su esencia, la actividad laboriosa marcó la vida de los individuos y de las colectividades en distintas épocas y locales.<br>It is a historical-social study that aimed at contributing for the comprehension of the continuous evolution of the working process since the Classic Antiquity until the industrialization in the modern world and the intimate relation with the worker. A variety of bibliographic sources were used for this essay, based on historical, conceptual, filosophical and scientific data. The findings drove to the conclusion that although deep transformations have occurred on the world of labor, the working activity, in its essence, has marked the lives of individuals and collectivities in different times and places

Permeable pavements and storm water management

The purpose of this book chapter is to summarize the recent literature on permeable pavements and related systems, highlighting current trends in research and practice, and to recommend future areas of research and development. Note that permeable pavements are also known as porous and pervious pavements depending on the industry and country of origin. The development of permeable pavements using concrete pavers as an integral part of sustainable drainage systems is reviewed in the context of traditional and modern urban drainage. Emphasis is given to detailed design, maintenance and water quality control aspects. The advantages and disadvantages of different pavement surfaces are discussed with the help of recent and relevant case study findings. The latest innovations are explained, and their potential for further research work is outlined. Current research regarding the development of systems combining geothermal heating and cooling, water treatment and recycling, and pavement is promising