Prof. Luigi Paolo Badano,
One of the main themes of EuroEcho 2009 has been three-dimensional echocardiography (3D Echo). According to Dr. Badano’s report, the main advantages of the 3D Echo technique over the established two-dimensional one can be summarized as follows:
From the clinical point of view, the increased accuracy in assessing left ventricular size and function can translate into better selection of patients who are candidates for costly device implantation or cardiac surgery. Expanded quantification capabilities allow unprecedented assessment of disease severity, like atrial septal defect and tricuspid valve stenosis planimetry, and assessment of geometry and function of cardiac chambers, like the right ventricle, which cannot be done in a reliable way using two-dimensional echocardiography. Prof. Voigt from Leuven reported about deformation imaging and the new parameters of myocardial (strain and strain rate) and ventricular function (twisting and rotation) that help in better understanding left ventricular function in various heart diseases, like aortic stenosis and cardiomyopathies, and to obtain an objective assessment of regional function. New echo techniques like speckle tracking overcome the technical limitations (e.g. angle dependency) of strain and strain rate calculated from Tissue Doppler and make it possible to assess myocardial deformation in all directions (longitudinal, radial and circumferential) in any segment of the left ventricle, including apical ones. Speckle tracking technique can be applied also to track the moving particles within the intracavitary blood and to assess the fluid dynamics during the cardiac cycle. This technique will open a completely new field in the echocardiographic study of cardiac function. Dr Popescu from Bucharest reported about the use of echo to assess cardiomyopathies. Using magnetic resonance imaging, it has been found that patients with obstructive hypertrophic cardiomyopathies have a higher extent of myocardial fibrosis and higher left ventricular filling pressures than patients with non-obstructive disease. In addition, it has been demonstrated that in patients with hypertrophic cardiomyopathy, the ratio E/e’ is not accurate to estimate left ventricular end-diastolic pressure. The new echo techniques (e.g. speckle tracking) allow to assess subclinical myocardial dysfunction in patients with preserved ejection fraction, as may occur in patients treated with anthracyclines. In patients with arrhythmogenic cardiomyopathy, there is a different pattern of evolution of right and left ventricular function over time. Those patients who show a normal left ventricular function after 24 months from diagnosis are characterized by an improved survival. In addition, those who improve biventricular function during treatment have a better prognosis. Finally, in patients with Fabry disease, there is a different pattern of hypertrophy between genders. Female patients are characterized by less extent of left ventricular hypertrophy and more fibrosis. Prof Garcia Fernandez reported about the use of 3D transesophageal echo in guiding interventional procedures in the cath lab. The technique is very useful in guiding transcatheter aortic valve implantation, atrial septal defect/patent foramen ovale closure and mitral balloon valvuloplasty, but it is essential in procedures like mitral valve clipping, device closure of paraprosthetic leaks and closure of left atrial appendage. A team approach between the echocardiographer and the interventional cardiologist is a key for the success of such procedures.
Highlights from Euroecho 2009
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