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

Three-dimensional echocardiography (3DE) facilitates data acquisition, dynamic display of functional anatomy of cardiac abnormalities, congenital defects and the possibility of online quantitative analysis of cardiac chambers and heart valves. Transthoracic 3DE has been used to determine cardiac chamber volumes and function due to the lack of geometric assumptions about their shape and the avoidance of apical view foreshortening, unlike the volume calculations derived from 2DE views. Transesophageal 3DE has been used mostly to assess heart valve anatomy and function.

Technological advances and the miniaturization of ultrasound equipment have led to the use of echocardiography in a variety of departments, including critical care and emergency medicine. Technological advances have also improved the imaging quality, making diagnosis with ultrasound more reliable and effective. The market as a whole is driven by cutting-edge, groundbreaking technologies. In addition to market leaders such as GE Healthcare, SonoSite and Philips, companies including Zonare, Hitachi Aloka, Esaote, Analogic, Toshiba, Siemens Healthcare, U-Systems, Terason and Mindray are emerging leaders in ultrasound equipment manufacture and sales.

According to Dr. Kort, major technological improvements in ultrasound include “improved imaging and automated quantifications of valvular stenosis and regurgitation, and assessment and follow-up of the cardio-oncology patient using strain imaging.” It is also the modality of choice for the majority of follow-up studies for assessment of disease progression, she added. Dr. Desai explained how the technology has evolved from M-mode echos in the 1970s and ‘80s, to the far more sophisticated developments involving color overlay over the moving images to highlight the heart valves and areas of leakage.

Hand-held ultrasound (HHU) facilitates the diagnosis and triage of patients presenting with cardiovascular emergencies. “Hand-held machines are utilized for focused applications and are not intended to replace portables or full-sized machines,” says Dr. Mulvagh. “For example, in the context of the clinical assessment of a cardiac patient, hand-held ultrasound functions as an extension of the stethoscope, and can guide diagnosis, testing and management of patients.”

Hand-held devices facilitate visualization of body tissues and vessels during the procedure. According to Dr. Mulvagh, “the image quality of the hand-held devices is comparable to the full-sized machine.” However, current imaging technology involving the hand-held tools is restricted to 2-D and color Doppler. No digital connectivity or image storage is currently feasible, although it may soon be available on a few hand-held devices. Dr. Desai agrees that the hand-held device is a “glorified stethoscope,” but still needed for initial diagnosis in an emergency setting before the patient is referred to a regular echocardiographic screening. “A full-fledged, hand-held probe is still five to 10 years down the road.”

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