The emergence and wider use of these techniques over the past two decades - in echocardiography, magnetic resonance imaging, cardiac computed tomography - have been accompanied by a corresponding decline in mortality related to coronary artery disease, which, says Dr Luigi Badano, chairman of the Congress Programme Committee, must partly be explained by the expanding role of imaging technology.
Now, with such rapid development in imaging techniques, it seems likely that non-invasive imaging will gain more importance in clinical cardiology - and likely too that in the near future these more accurate tests will revolutionise the diagnostics of cardiac diseases. EUROECHO 2009 will present the latest evidence highlighting the relative role of this technology.
More than 3,000 participants are expected to attend this year’s congress, whose two main themes are cardiomyopathies (deterioration in the function of the heart muscle as a result of disease) and three-dimensional echocardiography.
In patients with known or suspected coronary heart disease (CHD), cardiac imaging is principally used to diagnose the disease, assess its physiological extent and/or severity, stratify the risks, and assess viability of the heart muscle. Several imaging techniques are used to reach these goals, each with its own strengths and weaknesses. Right now, says Dr Badano, we do not yet know the added value of the new techniques (such as magnetic resonance imaging, MRI, and cardiac computed tomography, CCT) over the established techniques for improving the prognosis of CHD patients. New case reports presented at this congress will help clarify the appropriate place of this technology, to ensure its cost-effective use in the most beneficial way.
Three-dimensional echocardiography
3-D echo is a new non-invasive technique which expands the diagnostic capabilities of 2-D cardiac ultrasound and provides a detailed image of the heart's anatomy within its surrounding structures. Dr Badano describes three current developments in 3-D echo which are proposed for use: the detailed assessment of cardiac structures to help surgeons plan interventions before (and during) cardiac surgery; the in vivo monitoring of device implantation during percutaneous interventions; and the assessment of the size and function of the left and right ventricles as an aid to assess patient prognosis. These applications are only possible because of the comprehensive view of the heart which 3-D echo makes possible.
Cardiomyopathies
Cardiomyopathies represent a range of primary and secondary disorders in which there is an impairment of heart muscle function. These disorders might range from congenital heart defects (a primary cardiomyopathy) or depressed function of the heart muscle. Because the cardiomyopathies are invariably accompanied by dilation and/or hypertrophy, imaging is a powerful tool for accurate diagnosis, to plan management and to assess prognosis. Any dilation can be visualised, and overall heart function assessed. Computed tomography, echocardiography or MRI scanning will all provide a clear image which reflects how much of the myocardium is still alive and functioning - and thus what the most appropriate treatment might be. "All these techniques can be used in these patients," says Dr Badano, "but we still need clear evidence of which one is the most effective - and most cost-effective."
Cost, adds Dr Badano, is an important consideration. "We know that the cost of imaging increased by 70% from 2000 to 2007," he says, "compared with a 15% increase in the costs of all other medical services. We also know that at least 18% of these tests are inappropriate and in at least a further 16% their appropriateness is uncertain. So we are now looking for the most cost-effective way of assessing our patients using these new techniques." Presentations at this congress will add to that evidence base.
Costs, however, are not the only issue. Dr Badano adds that the amount of radiation and the related risk of malignancies to which we expose patients with computed tomography and nuclear imaging is also a consideration.
"Thus," he says, "since continued growth in imaging is clearly unsustainable, we need to rethink its use in order to select the technique or combination of techniques which maximise benefit but minimise risks and costs for each clinical situation - and hopefully for each patient."
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