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Study aim To explore various sources of variability in the measurement of LV volumes and dyssynchrony by 3D echocardiography (3DE). Methods We studied 100 patients (58 ± 18 years, 51 men) to assess the impact of: (1) manual editing; (2) 3D data set temporal resolution; (3) LV 16- or 17-segmentation model; (4) software sensitivity for automated endocardial surface detection; and (5) image quality, on the measurement of LV end-diastolic (EDV) and end-systolic (ESV) volumes, sphericity indices (EDSI, ESSI), ejection fraction (EF) and dyssynchrony (SDI). Two- and 4-beat LV full-volume data sets were analyzed and compared. Cardiac magnetic resonance (CMR) was used as reference in 26 patients. Results Manual editing of endocardial surface improved the agreement of LV volumes with CMR, but increased SDI (SDI17: 5.6 ± 0.5% vs. 4.3 ± 0.3%; P < 0.0001). Data set temporal resolution had no significant impact on LV parameters. Adding the 17th to 16-segment LV model did not significantly increase SDI. Reducing software sensitivity in endocardial surface detection increased EDV (101 ± 46 ml vs. 118 ± 50 ml) and sphericity, decreased SDI (SDI 17: 6.7 ± 3.3% vs. 2.9 ± 3.7%) (P < 0.05 for all), and improved agreement of EDV and ESV with CMR. Impact of software sensitivity in LV endocardium detection on LV parameters was related to image quality: higher on SDI in pts with suboptimal quality (SDI 17 bias 4.5% vs. 3.2%, P < 0.05); higher on LV volumes in patients with optimal quality (EDV bias 14 ml vs. 19 ml, ESV bias 5 ml vs. 9 ml; P = 0.01). Conclusions Manual editing, software settings and image quality significantly impact on 3D LV volumes and dyssynchrony assessment.

Aims: To assess the accuracy and reproducibility of a novel automated software for left ventricular (LV) volumes and ejection fraction (EF) measurements using real-time three-dimensional echocardiography (3DE). Methods and results: A total of 103 patients with a wide range of LV volumes were analyzed with both 4D AutoLVQTM and 4D TomTecTM software. In 23 patients, a side-by-side comparison of LV volume and EF measurements was done between 3DE, 2DE, and cardiac magnetic resonance (CMR). Excellent correlation was found between 4D AutoLVQ and 4D TomTec [r = 0.98 for end-diastolic volume (EDV), 0.99 for end-systolic volume (ESV), and 0.97 for EF, P < 0.0001], with small biases and narrow limits of agreement: EDV 5.2 mL (-14 to 25 mL), ESV 2.9 mL (-10 to 16 mL), EF -0.2 (-7 to 6). Time of analysis was halved using 4D AutoLVQ with manual correction (1 min 52 s± 30 s) in comparison with 4D TomTec software (3 min 46 s ± 1 min 24 s). Both softwares showed similar accuracy in comparison with CMR (4D AutoLVQ biases -11.0 mL, -9.1 mL, and 2.9; 4D TomTec biases -8.3 mL, -7.4 mL, and 2.8 for EDV, ESV, and EF, respectively, P = NS for all) and good reproducibility. Conclusion: Novel 4D AutoLVQ software showed very good agreement with more time-consuming 4D TomTec software, having similar accuracy against CMR.

Background: Pregnancy during dialysis is increasingly being reported and represents a debated point in Nephrology. The small number of cases available in the literature makes evidence-based counselling difficult, also given the cultural sensitivity of this issue. Hence, the need for position statements to highlight the state of the art and propose the unresolved issues for general discussion. Methods: A systematic analysis of the literature (MESH, Emtree and free terms on pregnancy and dialysis) was conducted and expert opinions examined (Study Group on Kidney and Pregnancy; experts involved in the management of pregnancy in dialysis in Italy 2000–2013). Questions regarded: timing of dialysis start in pregnancy; mode of treatment, i.e. peritoneal dialysis (PD) versus haemodialysis (HD); treatment schedules (for both modes); obstetric surveillance; main support therapies (anaemia, calcium-phosphate parathormone; acidosis); counselling tips. Main results: Timing of dialysis start is not clear, considering also the different support therapies; successful pregnancy is possible in both PD and HD; high efficiency and strict integration with residual kidney function are pivotal in both treatments, the blood urea nitrogen test being perhaps a useful marker in this context. To date, long-hour HD has provided the best results. Strict, personalized obstetric surveillance is warranted; therapies should be aimed at avoiding vitamin B12, folate and iron deficits, and at correcting anaemia; vitamin D and calcium administration is safe and recommended. Women on dialysis should be advised that pregnancy is possible, albeit rare, with both types of dialysis treatment, and that a success rate of over 75 % may be achieved. High dialysis efficiency and frequent controls are needed to optimize outcomes.

Background Pregnancy on dialysis is increasingly being reported. This study evaluates the behavioural profile of the children of mothers on dialysis and the parental stress their mothers undergo when compared with a group of mothers affected by a different chronic disease (microcythaemia) and a group of healthy control mothers. Methods Between 2000 and 2012, 23 on-dialysis mothers gave birth to 24 live-born children in Italy (23 pregnancies, 1 twin pregnancy, one of the twins deceased soon after delivery); of these, 16 mothers and 1 father (whose wife died before the inquiry) were included in the study (1 mother had died and the father was unavailable; 2 were not asked to participate because their children had died and 3 were unavailable; children: median age: 8.5, min-max: 2-13 years). Twenty-three mothers affected by transfusion-dependent microcythaemia or drepanocitosis (31 pregnancies, 32 children) and 35 healthy mothers (35 pregnancies, 35 children; median age of the children: 7, min-max: 1-13 years) were recruited as controls. All filled in the validated questionnaires: 'Child Behaviour Checklist' (CBCL) and the 'Parental Stress Index-Short Form' (PSI-SF). Results The results of the CBCL questionnaire were similar for mothers on dialysis and healthy controls except for pervasive developmental problems, which were significantly higher in the dialysis group, while microcythaemia mothers reported higher emotional and behavioural problems in their children in 8 CBCL sub-scales. Two/16 children in the dialysis and 3/32 in the microcythaemia group had pathological profiles, as assessed by T-scores (p: ns). PSI-SF indicated a normal degree of parental stress in microcythaemia subjects and healthy controls, while mothers on dialysis declared significantly lower stress, suggesting a defensive response in order to minimize problems, stress or negativity in their relationship with their child. Conclusions According to the present analysis, the emotional and behavioural o