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Article ; Online: A case report of rapid diagnosis of atrial-oesophageal fistula by transthoracic echocardiogram with agitated saline injection.

Galante, Ori / Braiman, Dana / Haim, Moti / Kobal, Sergio L

European heart journal. Case reports

2023 Volume 7, Issue 6, Page(s) ytad254

Abstract: Background: Catheter ablation is a common treatment for atrial fibrillation (AF). Atrial-oesophageal fistula (AOF) is a rare yet fatal complication of catheter ablation. Chest computed tomography (CT) is the diagnostic modality of choice but may be ... ...

Abstract	Background: Catheter ablation is a common treatment for atrial fibrillation (AF). Atrial-oesophageal fistula (AOF) is a rare yet fatal complication of catheter ablation. Chest computed tomography (CT) is the diagnostic modality of choice but may be undiagnostic in up to 24% of cases. Case summary: We present the case of a 61-year-old male who presented with pleuritic chest pain, hypotension, fever, and coffee-ground emesis 20 days after cryoablation for AF. His chest CT was undiagnostic. Atrial-oesophageal fistula was diagnosed by injecting agitated saline into the nasogastric tube during a transthoracic echocardiogram (TTE) that showed bubbles in the left atrium and ventricle. Discussion: In the case presented, as often happens, the diagnosis of AOF was delayed for several days, during which the patient presented with septic shock and concomitant multiorgan failure. The high mortality rate associated with AOF is partially attributable to delayed diagnosis. As prompt surgical intervention offers the best chance of survival, a high level of suspicion is of the utmost importance. We suggest contrast-enhanced TTE as a potential diagnostic tool when a rapid and definitive diagnosis is crucial and CT is inconclusive. Since this procedure is not without risk, proper risk consideration and management are necessary.
Language	English
Publishing date	2023-05-29
Publishing country	England
Document type	Case Reports
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/ytad254
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Article ; Online: Self-learning of cardiac ultrasound by medical students: can augmented online training improve and maintain manual POCUS skills over time?

Gat, Tomer / Galante, Ori / Sadeh, Re'em / Kobal, Sergio L / Fuchs, Lior

Journal of ultrasound

2023 Volume 27, Issue 1, Page(s) 73–80

Abstract: Background: The use of cardiac point of care ultra-sound is rapidly growing and so is the demand for quality POCUS teaching. POCUS teaching is usually conducted in small groups requiring much space and equipment. This study attempts to test whether ... ...

Abstract	Background: The use of cardiac point of care ultra-sound is rapidly growing and so is the demand for quality POCUS teaching. POCUS teaching is usually conducted in small groups requiring much space and equipment. This study attempts to test whether providing access to an E-learning module as an adjunct to a cardiac POCUS course can increase students' image acquisition skills. This will show POCUS teaching can improve significantly without having to invest a significant amount of resources. Methods: Medical students (N = 125) were divided into two groups and had undergone a hands-on Cardiac POCUS course before their internal clerkship. During the clerkship, members of both groups got to practice their POCUS skills in the internal wards. One group was provided with accounts to a cardiac POCUS teaching E-learning platform (eMedical Academy Results: The E-learning group performed significantly better than the course-only group in the 6-min exam total score, and at acquiring the following views: parasternal long axis view, apical four-chamber view, and the inferior vena cava view. Conclusion: E-learning platforms can be an efficient tool for improving cardiac POCUS teaching and maintaining POCUS skills. Using it as a supplement to a hands-on course provides better POCUS skills without the need of extra hands-on teaching.
MeSH term(s)	Humans ; Students, Medical ; Learning ; Echocardiography ; Heart/diagnostic imaging ; Time Factors
Language	English
Publishing date	2023-07-26
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2365426-0
ISSN	1876-7931 ; 1971-3495
ISSN (online)	1876-7931
ISSN	1971-3495
DOI	10.1007/s40477-023-00804-5
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Article: Downstream Imaging Studies Do Not Significantly Improve Outcome in Most Patients with Chest Pain Who Did Not Reach Their Target Heart Rate on a Stress ECHO Study.

Henkin, Nativ / Karilker, Ifat / Kobal, Sergio L / Golan, Rachel / Shalev, Aryeh / Atar, Shaul / Henkin, Yaakov

Journal of clinical medicine

2023 Volume 12, Issue 14

Abstract: Echocardiographic stress tests are often used to evaluate patients who complain of chest pain. However, some patients fail to reach the target heart rate required for the test to be conclusive (usually defined as 85% of the predicted maximal heart rate ... ...

Abstract	Echocardiographic stress tests are often used to evaluate patients who complain of chest pain. However, some patients fail to reach the target heart rate required for the test to be conclusive (usually defined as 85% of the predicted maximal heart rate based on the patient's age) and are often sent for additional imaging tests, such as myocardial perfusion imaging (MPI) or cardiac computed tomography angiography (CTA). Few studies have evaluated the effectiveness of these additional tests in patients who present with chest pain but did not meet the heart rate requirements for a stress test. The primary objective of the study was to evaluate the efficacy of additional imaging tests for patients who experience chest pain during daily activities but are unable to reach the target heart rate currently required for an echocardiographic stress test. The study group included 415 consecutive patients who underwent a stress echocardiogram, did not achieve their target heart rate, and did not demonstrate abnormal changes during the test. The control group consisted of 415 consecutive patients who did reach their target heart rate and demonstrated no signs of ischemia. Demographic and clinical data, medication use, imaging test results (MPI, CTA, and/or coronary catheterization) and documented cardiac events that occurred during 1 year of follow-up were obtained from the electronic medical records. Of the 415 patients in the study group, 73 (17.6%) were referred to another imaging test within 12 months. Of these 73 patients, 59 underwent MPI and 14 underwent cardiac CTA. In 12 of these patients (16.4%) the test was considered to be abnormal, but only 7 patients (1.7%) subsequently underwent a percutaneous intervention (PCI). In the control group, 28 (6.7%) patients were referred for another imaging test. Of these 28 patients, 14 underwent MPI and 14 underwent cardiac CTA. None of these tests were found to be abnormal, but two patients (0.5%) underwent a PCI (
Language	English
Publishing date	2023-07-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12144832
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Article ; Online: Embolisation of a prosthetic mitral valve fragment during valve-in-valve transcatheter mitral valve implantation.

Alnsasra, Hilmi / Koifman, Edward / Abu-Salman, Amjad / Kobal, Sergio L / Cafri, Carlos

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology

2021 Volume 17, Issue 18, Page(s) 1534–1535

MeSH term(s)	Cardiac Catheterization/adverse effects ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation/adverse effects ; Humans ; Mitral Valve/diagnostic imaging ; Mitral Valve/surgery ; Mitral Valve Insufficiency/diagnostic imaging ; Mitral Valve Insufficiency/surgery ; Treatment Outcome
Language	English
Publishing date	2021-11-28
Publishing country	France
Document type	Journal Article
ZDB-ID	2457174-X
ISSN	1969-6213 ; 1774-024X
ISSN (online)	1969-6213
ISSN	1774-024X
DOI	10.4244/EIJ-D-21-00630
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Zs.A 6680: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 571: Show issues

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Article ; Online: Accuracy and Efficacy of Hand-Held Echocardiography in Diagnosing Valve Disease: A Systematic Review.

Thomas, Felix / Flint, Nir / Setareh-Shenas, Saman / Rader, Florian / Kobal, Sergio L / Siegel, Robert J

The American journal of medicine

2018 Volume 131, Issue 10, Page(s) 1155–1160

Abstract: In recent years, advances in technology have enabled hand-held echocardiography (HHE) to generate high-quality 2-dimensional and color Doppler images. As these devices become smaller, simpler, and more affordable, the question of whether HHE can augment ... ...

Abstract	In recent years, advances in technology have enabled hand-held echocardiography (HHE) to generate high-quality 2-dimensional and color Doppler images. As these devices become smaller, simpler, and more affordable, the question of whether HHE can augment or replace auscultation as the primary mode of cardiovascular diagnosis has become increasingly more relevant. If widely implemented, HHE has the potential for significant cost savings and better resource utilization. This review examines studies comparing the sensitivities of auscultation, HHE, and standard echocardiography in detecting various valvular lesions and discusses why current evidence supports the use of HHE to augment the physical examination, which can lead to more reliable and rapid bedside diagnoses, triage, and appropriate treatment of structural cardiac abnormalities.
MeSH term(s)	Dimensional Measurement Accuracy ; Echocardiography/methods ; Echocardiography/standards ; Heart Valve Diseases/diagnosis ; Humans
Language	English
Publishing date	2018-05-30
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	80015-6
ISSN	1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
ISSN (online)	1555-7162 ; 1873-2178
ISSN	0002-9343 ; 1548-2766
DOI	10.1016/j.amjmed.2018.04.043
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Ua VI Zs.289: Show issues

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Article: [Portable ultrasound devices: a novel bedside approach for diagnosing cardiovascular disease].

Kobal, Sergio L / Horowitz, Itai / Liel-Cohen, Noah

Harefuah

2014 Volume 153, Issue 9, Page(s) 537–40, 557

Abstract: Bedside cardiovascular diagnosis by examination, palpation and auscultation is sub-optimal, even when performed by experts. While the diagnostic accuracy of imaging techniques is superior to physical examination, the feasibility of its integration into ... ...

Abstract	Bedside cardiovascular diagnosis by examination, palpation and auscultation is sub-optimal, even when performed by experts. While the diagnostic accuracy of imaging techniques is superior to physical examination, the feasibility of its integration into bedside examination has been precluded by the size and cost of imaging technology. Beyond these practical limitations, expertise in image acquisition and assessment is required. Nonetheless, these problems could be resolved by a low cost, easy to use, portable imaging device that could be used routinely at the bedside. Small, high-resolution cardiac ultrasound units have been developed. Published studies have demonstrated a remarkable increase in the accuracy of cardiovascular diagnosis by cardiologists and non-cardiologists when they added a brief cardiac ultrasound study to their conventional physical examination. This new diagnostic methodology is becoming common practice among cardiologists and non- cardiologists. As its use is becoming more popular, several factors must be resolved, such as: Which personnel may use it? Is the training necessary or compulsory? Which entities are responsible for training and continuous education? decisions regarding documentation, of findings and exams, and more. In this review, we will provide the latest literature updates and discuss whether there is enough evidence to justify the use of ultrasound mobile devices for a focused ultrasound examination to complement the traditional physical examination.
MeSH term(s)	Cardiovascular Diseases/diagnosis ; Cardiovascular Diseases/diagnostic imaging ; Echocardiography/instrumentation ; Equipment Design ; Humans ; Point-of-Care Systems
Language	Hebrew
Publishing date	2014-09
Publishing country	Israel
Document type	Journal Article ; Review
ZDB-ID	953872-0
ISSN	0017-7768
ISSN	0017-7768
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Zs.B 291: Show issues

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Article ; Online: Peer-teaching cardiac ultrasound among medical students: A real option.

Ben-Sasson, Alon / Lior, Yotam / Krispel, Jonathan / Rucham, Moshe / Liel-Cohen, Noah / Fuchs, Lior / Kobal, Sergio L

PloS one

2019 Volume 14, Issue 3, Page(s) e0212794

Abstract: Introduction: Teaching cardiac ultrasound (CU) image acquisition requires hands-on practice under qualified instructors supervision. We assessed the efficacy of teaching medical students by their previously trained classmates (teaching assistants [TAs]) ...

Abstract	Introduction: Teaching cardiac ultrasound (CU) image acquisition requires hands-on practice under qualified instructors supervision. We assessed the efficacy of teaching medical students by their previously trained classmates (teaching assistants [TAs]) compared to teaching by expert trainers (cardiologists or diagnostic medical sonographers. Methods: Sixty-six students received 8-hour CU training: 4-hour lectures on ultrasound anatomy and imaging techniques of 6 main CU views (parasternal long [PLAV] and short axis [PSAV]; apical 4-chamber [4ch], 2-chamber [2ch], and 3-chamber [3ch]; and sub costal [SC]) followed by 4 hours of hands-on exercise in groups of ≤5 students under direct supervision of a TA (group A: 44 students) or a qualified trainer (group B: 22 students). Students' proficiency was evaluated on a 6-minute test in which they were required to demonstrate 32 predetermined anatomic landmarks spread across the 6 views and ranked on a 0-100 scale according to a predetermined key. Results: The 6-minute test final grade displayed superiority of group A over group B (54±17 vs. 39±21, respectively [p = 0.001]). This trend was continuous across all 6 main views: PLAV (69±18 vs. 54±23, respectively), PSAV (65±33 vs. 41±32, respectively), 4ch (57±19 vs. 43±26, respectively), 2ch (37±29 vs. 33±27, respectively), 3ch (48±23 vs. 35±25, respectively), and SC (36±27 vs. 24±28, respectively). Conclusions: Teaching medical students CU imaging acquisition by qualified classmates is feasible. Moreover, students instructors were superior to senior instructors when comparing their students' capabilities in a practical test. Replacing experienced instructors with TAs could help medical schools teach ultrasound techniques with minimal dependence on highly qualified trainers.
MeSH term(s)	Adult ; Clinical Competence ; Curriculum ; Echocardiography ; Education, Medical, Undergraduate/methods ; Educational Measurement/statistics & numerical data ; Feasibility Studies ; Female ; Heart/diagnostic imaging ; Humans ; Male ; Peer Group ; Program Evaluation ; Prospective Studies ; Schools, Medical ; Students, Medical/statistics & numerical data ; Teaching
Language	English
Publishing date	2019-03-27
Publishing country	United States
Document type	Journal Article
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0212794
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Article ; Online: Global longitudinal strain and long-term outcome in patients presenting to the emergency department with suspected acute coronary syndrome.

Fuks, Alexander / Liel-Cohen, Noah / Blondheim, David S / Shimoni, Sara / Jabaren, Mohamed / Leitman, Marina / Adawi, Salim / Jaffe, Ronen / Karkabi, Basheer / Asmer, Ihab / Ganaeem, Majdi / Kobal, Sergio L / Lavi, Idit / Saliba, Walid / Shiran, Avinoam

Echocardiography (Mount Kisco, N.Y.)

2021 Volume 38, Issue 8, Page(s) 1254–1262

Abstract: Aims: We have previously shown that 2-dimentional strain is not a useful tool for ruling out acute coronary syndrome (ACS) in the emergency department (ED). The aim of the present study was to determine whether in patients with suspected ACS, global ... ...

Abstract	Aims: We have previously shown that 2-dimentional strain is not a useful tool for ruling out acute coronary syndrome (ACS) in the emergency department (ED). The aim of the present study was to determine whether in patients with suspected ACS, global longitudinal strain (GLS), measured in the ED using 2-dimensional strain imaging, can predict long-term outcome. Methods: Long-term (median 7.7 years [IQR 6.7-8.2]) major adverse cardiac events (MACE; cardiac death, ACS, revascularization, hospitalization for heart failure, or atrial fibrillation) and all-cause mortality data were available in 525/605 patients (87%) enrolled in the Two-Dimensional Strain for Diagnosing Chest Pain in the Emergency Room (2DSPER) study. The study prospectively enrolled patients presenting to the ED with chest pain and suspected ACS but without a diagnostic ECG or elevated troponin. GLS was computed using echocardiograms performed within 24 hours of chest pain. MACE of patients with worse GLS (>median GLS) were compared to patients with better GLS (≤ median GLS). Results: Median GLS was -18.7%. MACE occurred in 47/261 (18%) of patients with worse GLS as compared with 45/264 (17%) with better GLS, adjusted HR 0.87 (95% CI 0.57-1.33, P = .57). There was no significant difference in all-cause mortality or individual endpoints between groups. GLS did not predict MACE even in patients with optimal 2-dimensional image quality (n = 164, adjusted HR=1.51, 95% CI 0.76-3.0). Conclusions: Global longitudinal strain did not predict long-term outcome in patients presenting to the ED with chest pain and suspected ACS, supporting our findings in the 2DSPER study.
MeSH term(s)	Acute Coronary Syndrome/diagnostic imaging ; Chest Pain/diagnostic imaging ; Echocardiography ; Emergency Service, Hospital ; Humans ; Predictive Value of Tests
Language	English
Publishing date	2021-06-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	843645-9
ISSN	1540-8175 ; 0742-2822
ISSN (online)	1540-8175
ISSN	0742-2822
DOI	10.1111/echo.15129
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Zs.A 2170: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 359: Show issues

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Article ; Online: Early Point-of-Care Ultrasound Assessment for Medical Patients Reduces Time to Appropriate Treatment: A Pilot Randomized Controlled Trial.

Ben-Baruch Golan, Yael / Sadeh, Re'em / Mizrakli, Yuval / Shafat, Tali / Sagy, Iftach / Slutsky, Tzachi / Kobal, Sergio L / Novack, Victor / Fuchs, Lior

Ultrasound in medicine & biology

2020 Volume 46, Issue 8, Page(s) 1908–1915

Abstract: Numerous studies emphasize the diagnostic importance of point-of-care ultrasound (POCUS), but the level of evidence remains low as most data are gathered from observational studies. We conducted a pilot, randomized controlled trial to evaluate the effect ...

Abstract	Numerous studies emphasize the diagnostic importance of point-of-care ultrasound (POCUS), but the level of evidence remains low as most data are gathered from observational studies. We conducted a pilot, randomized controlled trial to evaluate the effect of POCUS exam on medical patient's management and clinical outcomes. Patients presenting with chest pain or dyspnea were enrolled and randomly allocated to an early POCUS scan group and a control group. POCUS assessment, within 24 h of internal ward admission, was conducted only for the intervention group. The primary outcome was time to correct diagnosis. Secondary outcomes included time to appropriate treatment, POCUS-related rate of primary diagnosis alteration and new clinically relevant findings and time to hospital discharge. Sixty patients were enrolled. Thirty patients were randomly allocated to each study arm. The POCUS exam revealed clinically relevant findings among 79% of patients and led to alteration of the primary diagnosis among 28% of patients. Time to appropriate treatment was significantly shorter among patients in the POCUS group compared with the control group (median time of 5 h [95% confidence interval: 0.5-9] vs. 24 h [95% CI: 19-29] p = 0.014). The time needed to achieve correct diagnosis by the primary team was shorter in the POCUS group compared with the control group, yet it did not reach statistical significance (median time of 24 h [95% CI: 18-30] vs. 48 h [95% CI: 20-76], p = 0.12). These results indicate that POCUS assessment conducted early among patients with dyspnea or chest pain improves diagnostic accuracy and shortens significantly the time to appropriate treatment.
MeSH term(s)	Aged ; Aged, 80 and over ; Humans ; Pilot Projects ; Point-of-Care Testing ; Time Factors ; Ultrasonography/methods
Language	English
Publishing date	2020-05-16
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	186150-5
ISSN	1879-291X ; 0301-5629
ISSN (online)	1879-291X
ISSN	0301-5629
DOI	10.1016/j.ultrasmedbio.2020.03.023
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Zs.A 963: Show issues

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Article ; Online: The feasibility and efficacy of implementing a focused cardiac ultrasound course into a medical school curriculum.

Kobal, Sergio L / Lior, Yotam / Ben-Sasson, Alon / Liel-Cohen, Noah / Galante, Ori / Fuchs, Lior

BMC medical education

2017 Volume 17, Issue 1, Page(s) 94

Abstract: Background: Teaching cardiac ultrasound to medical students in a brief course is a challenge. We aimed to evaluate the feasibility of teaching large groups of medical students the acquisition and interpretation of cardiac ultrasound images using a ... ...

Abstract	Background: Teaching cardiac ultrasound to medical students in a brief course is a challenge. We aimed to evaluate the feasibility of teaching large groups of medical students the acquisition and interpretation of cardiac ultrasound images using a pocket ultrasound device (PUD) in a short, specially designed course. Methods: Thirty-one medical students in their first clinical year participated in the study. All were novices in the use of cardiac ultrasound. The training consisted of 4 hours of frontal lectures and 4 hours of hands-on training. Students were encouraged to use PUD for individual practice. Finally, the students' proficiency in the acquisition of ultrasound images and their ability to recognize normal and pathological states were evaluated. Results: Sixteen of 27 (59%) students were able to demonstrate all main ultrasound views (parasternal, apical, and subcostal views) in a six-minute test. The most obtainable view was the parasternal long-axis view (89%) and the least obtainable was the subcostal view (58%). Ninety-seven percent of students correctly differentiated normal from severely reduced left ventricular function, 100% correctly differentiated a normal right ventricle from a severely hypokinetic one, 100% correctly differentiated a normal mitral valve from a rheumatic one, and 88% correctly differentiated a normal aortic valve from a calcified one, while 95% of them correctly identified the presence of pericardial effusion. Conclusions: Training of medical students in cardiac ultrasound during the first clinical year using a short, focused course is feasible and enables students with modest ability to acquire the main transthoracic ultrasound views and gain proficiency in the diagnosis of a limited number of cardiac pathologies.
Language	English
Publishing date	2017-05-30
Publishing country	England
Document type	Journal Article
ZDB-ID	2044473-4
ISSN	1472-6920 ; 1472-6920
ISSN (online)	1472-6920
ISSN	1472-6920
DOI	10.1186/s12909-017-0928-x
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