Prof. Luigi Paolo Badano,
In this session, leaders of the European Association of Echocardiography (EAE) reported about the position papers produced by EAE on these important topics.
Prof J.U. Voigt from Leuven reported about the echocardiographic assessment of left ventricular mechanics. According to the EAE, echocardiography is ideally suited for the evaluation of cardiac mechanics because of its intrinsically dynamic nature. Today, new, increasingly automated techniques for sophisticated analysis of cardiac mechanics have been made available to researchers by manufacturers of ultrasound imaging equipment. Over the years several techniques have appeared and then disappeared (like the backscatter cyclic variation) from the research arena. Today, the techniques which have provided most of the research and clinical data: (1) Doppler-based tissue velocity measurements, frequently referred to as tissue Doppler or myocardial Doppler, and (2) speckle tracking on the basis of displacement measurements. Both types of measurements lend themselves to the derivation of multiple parameters of myocardial function. Prof Voigt summarized the current and potential clinical applications of these techniques and their strengths and weaknesses. Particular emphasis has been put on the role of echo to assess mechanical dissynchrony after the results of the PROSPECT study.
Dr Rosa Sicari from Pisa summarized the position of the EAE about the indications of new pocket size imaging devices, the educational needs of potential users other than cardiologists experts in echo, and the limitations of these devices. Pocket size imaging devices are not real echo machines and have been equipped with just 2D and color Doppler modalities on purpose. Their technical characteristics may be summarized as: 1. Gray scale images have a 2D sector angle < 75 degrees, depth < 25 cm 2. Color flow imaging (available in one product only) has a fixed colour box size and a fixed PRF 3. Measurements are restricted to distances and areas 4. Options for patient identification are limited 5. connectivity requires dedicated software tools. EAE recommendations about pocket size imaging devices can be summarized in: 1. Pocket size imaging devices do not provide a complete diagnostic echocardiographic examination. The range of indications for their use is therefore limited 2. Imaging assessment with pocket size imaging devices should be reported as part of the physical examination of the patient. Image data should be stored according to the applicable national rules for technical examinations 3. With the exception of cardiologists who are certified for transthoracic echocardiography according to national legislation, specific training and certification is recommended for all users. The certification should be limited to the clinical questions that can potentially be answered by pocket size devices 4. The patient has to be informed that an examination with the current generation of pocket size imaging devices does not replace a complete echocardiogram.
Prof Jose Luis Zamorano from Madrid reported about the use of echo in guiding interventional procedures. The introduction of devices for transcatheter aortic valve implantation, mitral repair, and closure of prosthetic paravalvular leaks has led to a greatly expanded armamentarium of catheter-based approaches to patients with regurgitant as well as stenotic valvular disease. Echocardiography plays an essential role in identifying patients suitable for these interventions, in providing intra-procedural monitoring, and assessing final procedural results and occutrring complications. Moreover, echocardiography is the primary modality for post-procedure follow-up. The echocardiographic assessment of patients undergoing trans-catheter interventions places demands on echocardiographers that differ from those of the routine evaluation of patients with native or prosthetic valvular disease.
Finally, Prof Andreas Hagendorf from Leipzig reported on an unpublished document about use of echo in the emergency department. The main points underlined by Prof Hagendorf have been the need for high quality machines and for highly experienced operators to obtain the right information to take the proper decision in order to calculate patient management. The role of the new technologies has been emphasized.
Hot topics in echocardiography: the position of the European Association of Echocardiography
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