Echocardiography's expanding role in cardiovascular diagnosis and management

by Sridhar Nadamuni, Contributing Reporter | March 07, 2017
From the March 2017 issue of HealthCare Business News magazine

“Electrocardiography is the mainstay of cardiac diagnosis, and the frequency of its usage far outweighs that of CT scans and MRIs,” says Milind Desai, M.D., a staff cardiologist in the Section of Cardiovascular Imaging in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at the Sydell and Arnold Miller Family Heart & Vascular Institute at Cleveland Clinic. Over 70,000 echocardiograms are done at the Cleveland Clinic annually, and Dr. Desai reads nearly 2,500 echocardiograms, 1,000 cardiac CTs and 300 cardiac MRIs.

Dr. Mulvagh commented that echocardiography is the first choice in cardiac diagnosis as it is “radiation-free, relatively low-cost, portable and available throughout the world, especially for patients who are infirm or fragile.” It has been approved for use in the largest variety of patient cardiac needs.

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Dr. Desai explains that ultrasound is used following an initial electrocardiogram (ECG), for instance, when an ECG is normal, but the patient continues to complain of chest pain. Physical examination has poor diagnostic accuracy, and leads to false-negative or false-positive outcomes in detecting cardiac pathology approximately 50 percent of the time when compared with transthoracic echocardiography (TTE) in both the acute and outpatient settings. The most common pathologies missed by clinical examination include aortic stenosis and cardiac failure, which account for nearly 2 percent to 3 percent in the general population and 10 percent to 20 percent in the population age 75 or older.

However, “history and physical examination always come first, and echocardiography is a close second,” according to cardiologist Michael W. Cullen, M.D., FACC, who is affiliated with numerous hospitals, including the Department of Cardiovascular Diseases at the Mayo Clinic. “Echocardiography plays a key role in diagnosing valvular and congenital heart disease, hypertrophic cardiomyopathy and atrial fibrillation.” It is an excellent choice for the determination of cardiac structure and function, and hemodynamic and physiological evaluation as well as in the diagnosis of valvular stenosis and regurgitation, determination of pulmonary filling pressures, stroke volume and cardiac output.

Ultrasound technology offers a standardized, qualitatively superior, broad and reproducible method to ensure the quality, reliability, reproducibility and overview of hemodynamic and intravascular volume status data. It facilitates the determination of the basic venous collapsibility and overall cardiac status as well as the condition of cardiac flow and tissue Doppler signals. Dr. Kort highlighted the advantages, including “low cost compared with other imaging modalities such as CT or MRI, small size of the equipment that does not require [a] special facility, lack of ionizing radiation or use of contrast material that could impact renal function.” Echocardiography performed in a high-quality laboratory is reliable, associated with small variability and allows appropriate follow-up of patients.

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