The first-line test in patients with a suspicion of cardiovascular disease – including arterial disease and heart failure - should now be echocardiography, says Professor Jose Luis Zamorano, Chair of the Programme Committee for EUROECHO 2008 and EAE President-Elect.
Professor Zamorano, from the San Carlos University Clinic in Madrid, Spain, describes echocardiography as “crucial” in all types of heart disease, not just to confirm diagnosis but also to exclude the possibility of disease; “so echocardiography is excellent in diagnosis and prognosis”, he adds.
The principal advantage of routine echocardiography, which uses ultrasound waves to produce an image of the heart, is its non-invasive nature. A transducer placed on the thorax can produce accurate images of the heart’s four chambers, the valves and aorta, and tissue damage, and thereby provide information on blood flow, pumping capacity and coronary arteries.
An alternative – and usually more accurate - image can be provided by transesophageal echocardiography, by which the transducer is passed directly into the patient’s esophagus, thereby avoiding the thoracic barriers of skin, fat and bone.
Two other technological developments will be reviewed at EUROECHO 2008: the development of portable echocardiographic systems; and the rapid introduction of three-dimensional echo. The congress will also feature two formal scientific themes: stress echo as one of the major diagnostic tests for coronary artery disease; and the application of echocardiography in patients with heart failure, presently the world’s fastest growing cardiovascular disease.
Portable – even miniature and pocket – echo systems are easy to use, have the same definition and accuracy as traditional modalities, but now bring their diagnostic capability outside the hospital. The latest guidelines in emergency coronary care stress the importance of speedy intervention and diagnosis as much as the application of appropriate treatments. Portable systems, which are easily used by a wide range of physicians, are increasingly incorporated into acute coronary care programmes.
By the development of matrix probes and complex processing systems, 3D echocardiography is now possible and in rapid evolution, providing graphic anatomical images of the heart. “3D is a big step forward,” says Professor Zamorano, “and will be the number one technique in the very near future.” Currently, 3D echo technology has been used to notable effect in valvular heart disease (mitral and aortic valve) and in assessing left ventricular function.
Introduced at EUROECHO 2008 and newly available on the website of the European Association of Echocardiography is the “3D Echo Box”, a real-time three-dimensional echo compendium of clinical cases, webcasts, and resource bank of videos and photos designed to provide a one-stop reference point for echocardiographers.
Stress echo is now one of the prime-time tests for patients suspected of coronary artery disease. Stress echo (along with 3D echo and cardiac resynchronisation therapy) will feature in a newly launched “Imaging Campus” at EUROECHO 2008, a series of individualised hands-on training sessions in which congress participants will be guided through the practical techniques of echo imaging and patient contact.
“All patients with presumed heart failure should have at least one echo test,” says Professor Zamorano. Yet this, in the most prevalent cardiovascular disease, is not yet the reality in Europe. The SHAPE survey reported earlier this year that primary care physicians and geriatricians displayed less-than-optimal use of echocardiography for a diagnosis of heart failure, relying instead on “signs and symptoms”. However, echo was unavailable to more than 50 per cent of the primary care physicians. This, adds Professor Zamorano, is a concern; a wrong diagnosis may well mean the wrong treatment.
Professor Petros Nihoyannopoulos from the National Heart and Lung Institute in London and outgoing President of the European Association of Echocardiography describes echocardiography as “the most important diagnostic imaging modality in cardiology”, adding: “I am convinced that echocardiography will be the major sub-specialty in cardiology for the next 20 years and beyond.”
EUROECHO 2008, which is now the world’s largest scientific gathering on echocardiography, will take place in Lyon, France, from 10-13th December. EUROECHO 2008 is the twelfth Annual Meeting of the European Association of Echocardiography, a registered branch of the European Society of Cardiology
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