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Dr. Sicari Rosa
New technologies applied to ultrasounds have recently been implemented in order to overcome the two major limitations of echocardiography: subjectivity and sub-optimal image quality. Quantification in echocardiography remains a challenge and many experimental tools have been identified to quantify regional and global function. During the session, the speakers illustrated thoroughly the topics they were each assigned.
Alan Fraser provided a deep and learned description of how Tissue Doppler Indices (TDI) and its derivatives work, showing also the pitfalls of the technique. Even though during the discussion he stated that TDI and its derivatives are part of a complete echocardiogram, at least in his laboratory, he did not provide evidence that the innovative tools are additive when compared to standard, cheaper and easier ones to analyse. In the second talk Tony DeMaria followed Fraser’s path outlining the advantages of TDI and then discussed velocity vector imaging, still a research tool to be further implemented and still outside the clinical arena. Mark Monaghan provided a complete overview of the use of 3D in clinical practice, and focused his presentation on resynchronization therapy. Interestingly enough, he mentioned that to quantitative methods such as TDI and derivatives, he prefers 3D and contrast. The last presentation was on contrast. Tony DeMaria, a pioneer of the technique, gave us a quite balanced view on the use of contrast: it is still after almost 20 years the technique to come. Its common use is to enhance myocardial border in sub-optimal studies and the lack of standard protocol and sound clinical and outcome data collected on a multicenter basis makes it a promising but not established technology.
Quantitative assessment by ultrasound remains a scientific challenge and a clinical goal but the time has not come for these newer ultrasonographic techniques, which should be restricted to research laboratories. No consensus among experts can be reached on which parameter is best and the relative technology to apply. The introduction of a new technology for clinical routine use should pass through the different phases of scientific assessment from feasibility studies to large multicenter studies, from efficacy to effectiveness studies.
New methods to diagnose left ventricular function: ready for clinical practice? Clinical Seminar
List of presenters: Dr. Alan G Fraser, Cardiff, (UK) Dr Mani Vannan, Los Angeles, CA (no show replaced by Anthony De Maria) Mark J Monhagan (London, UK) Dr. Anthony De Maria (San Diego, CA)
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