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Role of Echocardiography in Cardiology Consultation

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Abstract

Echocardiography can be used to evaluate almost any cardiovascular disease process and provide structural/anatomical, functional, and hemodynamic information in real time at the patient’s bedside. It can be used in both stable and critically ill patients. This chapter discusses important elements and uses of transthoracic, transesophageal, and stress echocardiography that are important to consultative cardiology, including appropriate ordering, echocardiographic techniques, and standard and emerging clinical uses.

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References

  1. Silvestry FE, Kerber RE, Brook MM, Carroll JD, Eberman KM, Goldstein SA, Herrmann HC, Homma S, Mehran R, Packer DL, Parisi AF, Pulerwitz T, Seward JB, Tsang TS, Wood MA. Echocardiography-guided interventions. J Am Soc Echocardiogr. 2009;22(3):213–31.

    Article  PubMed  Google Scholar 

  2. Zamorano JL, Badano LP, Bruce C, Chan KL, Gonçalves A, Hahn RT, Keane MG, La Canna G, Monaghan MJ, Nihoyannopoulos P, Silvestry FE, Vanoverschelde JL, Gillam LD. EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. J Am Soc Echocardiogr. 2011;24(9):937–65.

    Article  PubMed  Google Scholar 

  3. American College of Cardiology Foundation Appropriate Use Criteria Task Force; American Society of Echocardiography; American Heart Association; American Society of Nuclear Cardiology; Heart Failure Society of America; Heart Rhythm Society; Society for Cardiovascular Angiography and Interventions; Society of Critical Care Medicine; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance, Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, Patel AR, Picard MH, Polk DM, Ragosta M, Ward RP, Weiner RB. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians. J Am Coll Cardiol. 2011;57(9):1126–66.

    Article  PubMed  Google Scholar 

  4. Saksena S, Sra J, Jordaens L, Kusumoto F, Knight B, Natale A, Kocheril A, Nanda NC, Nagarakanti R, Simon AM, Viggiano MA, Lokhandwala T, Chandler ML; ICE-CHIP Investigator Study Group. A prospective comparison of cardiac imaging using intracardiac echocardiography with transesophageal echocardiography in patients with atrial fibrillation: the intracardiac echocardiography guided cardioversion helps interventional procedures study. Circ Arrhythm Electrophysiol. 2010;3(6):571–7.

    Article  PubMed  Google Scholar 

  5. Lang RM, Mor-Avi V, Sugeng L, et al. Three dimensional echocardiography: the benefits of the addition dimension. J Am Coll Cardiol. 2006;48:2053–69.

    Article  PubMed  Google Scholar 

  6. Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T, Faletra FF, Franke A, Hung J, de Isla LP, Kamp O, Kasprzak JD, Lancellotti P, Marwick TH, McCulloch ML, Monaghan MJ, Nihoyannopoulos P, Pandian NG, Pellikka PA, Pepi M, Roberson DA, Shernan SK, Shirali GS, Sugeng L, Ten Cate FJ, Vannan MA, Zamorano JL, Zoghbi WA, American Society of Echocardiography; European Association of Echocardiography. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. J Am Soc Echocardiogr. 2012;25(1):3–46.

    Article  PubMed  Google Scholar 

  7. Mulvagh SL, Rakowski H, Vannan MA, Abdelmoneim SS, Becher H, Bierig SM, Burns PN, Castello R, Coon PD, Hagen ME, Jollis JG, Kimball TR, Kitzman DW, Kronzon I, Labovitz AJ, Lang RM, Mathew J, Moir WS, Nagueh SF, Pearlman AS, Perez JE, Porter TR, Rosenbloom J, Strachan GM, Thanigaraj S, Wei K, Woo A, Yu EH, Zoghbi WA, American Society of Echocardiography. American Society of Echocardiography Consensus statement on the clinical applications of ultrasonic contrast agents in echocardiography. J Am Soc Echocardiogr. 2008;21(11):1179–201.

    Article  PubMed  Google Scholar 

  8. Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, Galderisi M, Marwick T, Nagueh SF, Sengupta PP, Sicari R, Smiseth OA, Smulevitz B, Takeuchi M, Thomas JD, Vannan M, Voigt JU, Zamorano JL. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr. 2011;24(3):277–313.

    Article  PubMed  Google Scholar 

  9. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European association of echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440–63.

    Article  PubMed  Google Scholar 

  10. Tsang MY, Barnes ME, Tsang TS. Left atrial volume: clinical value revisited. Curr Cardiol Rep. 2012;14(3):374–80.

    Article  PubMed  Google Scholar 

  11. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685–713.

    Article  PubMed  Google Scholar 

  12. Shiga T, Wajima Z, Apfel CC, et al. Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis. Arch Intern Med. 2006;166:1350–6.

    Article  PubMed  Google Scholar 

  13. Barbieri A, Bursi F, Mantovani F, Valenti C, Quaglia M, Berti E, Marino M, Modena MG. Prognostic impact of left ventricular mass severity according to the classification proposed by the American Society of Echocardiography/European Association of Echocardiography. J Am Soc Echocardiogr. 2011;24(12):1383–91.

    Article  PubMed  Google Scholar 

  14. Hayley BD, Burwash IG. Heart failure with normal left ventricular ejection fraction: role of echocardiography. Curr Opin Cardiol. 2012;27(2):169–80.

    Article  PubMed  Google Scholar 

  15. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22(2):107–33.

    Article  PubMed  Google Scholar 

  16. Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Iung B, Otto CM, Pellikka PA, Quiñones M, American Society of Echocardiography; European Association of Echocardiography. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009;22(1):1–23.

    Article  PubMed  Google Scholar 

  17. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ, American Society of Echocardiography. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16(7):777–802.

    Article  PubMed  Google Scholar 

  18. Zoghbi WA, Chambers JB, Dumesnil JG, Foster E, Gottdiener JS, Grayburn PA, Khandheria BK, Levine RA, Marx GR, Miller Jr FA, Nakatani S, Quiñones MA, Rakowski H, Rodriguez LL, Swaminathan M, Waggoner AD, Weissman NJ, Zabalgoitia M, American Society of Echocardiography’s Guidelines and Standards Committee; Task Force on Prosthetic Valves; American College of Cardiology Cardiovascular Imaging Committee; Cardiac Imaging Committee of the American Heart Association; European Association of Echocardiography; European Society of Cardiology; Japanese Society of Echocardiography; Canadian Society of Echocardiography; American College of Cardiology Foundation; American Heart Association; European Association of Echocardiography; European Society of Cardiology; Japanese Society of Echocardiography; Canadian Society of Echocardiography. Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Task Force on prosthetic valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009;22(9):975–1014.

    Article  PubMed  Google Scholar 

  19. Kirkpatrick JN, Wong T, Bednarz JE, Spencer KT, Sugeng L, Ward RP, DeCara JM, Weinert L, Krausz T, Lang RM. Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging. J Am Coll Cardiol. 2004;43(8):1412–9.

    Article  PubMed  Google Scholar 

  20. Pellikka PA, Nagueh SF, Elhendy AA, Kuehl CA, Sawada SG, American Society of Echocardiography. American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr. 2007;20(9):1021–41.

    Article  PubMed  Google Scholar 

  21. Gorcsan 3rd J, Abraham T, Agler DA, Bax JJ, Derumeaux G, Grimm RA, Martin R, Steinberg JS, Sutton MS, Yu CM, American Society of Echocardiography Dyssynchrony Writing Group. Echocardiography for cardiac resynchronization therapy: recommendations for performance and reporting – a report from the American Society of Echocardiography Dyssynchrony Writing Group endorsed by the Heart Rhythm Society. J Am Soc Echocardiogr. 2008;21(3):191–213.

    Article  PubMed  Google Scholar 

  22. Kirkpatrick JN, Wiegers SE, Rame JE, Lang RM. Use of echocardiography to optimize left ventricular assist devices. U S Cardiology. 2010;7(2):11–5.

    Google Scholar 

  23. Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, Douglas PS, Faxon DP, Gillam LD, Kimball TR, Kussmaul WG, Pearlman AS, Philbrick JT, Rakowski H, Thys DM, Antman EM, Smith Jr SC, Alpert JS, Gregoratos G, Anderson JL, Hiratzka LF, Hunt SA, Fuster V, Jacobs AK, Gibbons RJ, Russell RO. American College of Cardiology; American Heart Association; American Society of Echocardiography. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE committee to update the 1997 guidelines for the clinical application of echocardiography). Circulation. 2003;108(9):1146–62.

    Article  PubMed  Google Scholar 

  24. Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, Konstam MA, Mancini DM, Rahko PS, Silver MA, Stevenson LW, Yancy CW. 2009 focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119(14):1977–2016. Epub 2009 Mar 26.

    Article  PubMed  Google Scholar 

  25. Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Jr FDP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O’Gara PT, O’Rourke RA, Otto CM, Shah PM, Shanewise JS, American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;52(13):e1–142.

    Article  PubMed  Google Scholar 

  26. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey Jr DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM, American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American College of Radiology; American Stroke Association; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of Thoracic Surgeons; Society for Vascular Medicine. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol. 2010;55(14):e27–129.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Carol Dennis for her assistance with formatting of the manuscript.

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Authors and Affiliations

  1. Department of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Philip G. Haines BM, BCh, MPH, MRCP (UK), Nidhi Mehta MD & James N. Kirkpatrick MD

Authors
  1. Philip G. Haines BM, BCh, MPH, MRCP (UK)
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  2. Nidhi Mehta MD
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  3. James N. Kirkpatrick MD
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Corresponding author

Correspondence to James N. Kirkpatrick MD .

Editor information

Editors and Affiliations

  1. Division of Cardiology, Department of Medicine,, Stony Brook University, School of Medicine,, Stony Brook, USA

    Kathleen Stergiopoulos

  2. Division of Cardiology, Stony Brook University, Stony Brook, New York, USA

    David L. Brown

Electronic Supplementary Material

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Mitral valve in 3D (see Fig. 14.1). Three-dimensional transesophageal echocardiographic images of the mitral valve from the “surgeon’s view”—the left atrial perspective. The anterior leaflet is on top and the posterior leaflet is on the bottom. This technique provides a unique perspective from which to evaluate all scallops of the mitral valve leaflets—from left (lateral) to right (medial) aspects of the posterior leaflet, P1, P2, and P3, and the corresponding scallops of the anterior leaflet, A1, A2, and A3. In this patient there is also a medial commissural leaflet (CL) which is located at the intersection of the anterior and posterior leaflets. The video demonstrates prolapse of the P2 segment (middle portion of the posterior leaflet) and P3 (medial or rightward portion of the posterior leaflet) (AVI 42191 kb)

271988_1_En_14_MOESM2_ESM.avi

Stress-induced cardiomyopathy (see Fig. 14.2). Apical four-chamber view demonstrates akinesis of the mid chamber to the apex, consistent with either multivessel coronary ischemia or stress-induced cardiomyopathy (Takotsubo). (AVI 7035 kb)

Stress-induced cardiomyopathy (see Fig. 14.2). Several weeks later, repeat echocardiography demonstrates complete resolution of the wall motion abnormalities, consistent with a diagnosis of stress-induced cardiomyopathy (AVI 11966 kb)

Echodensity filling the left ventricle (see Fig. 14.3). The left ventricle is filled from the mid wall to the apex with a large echodensity. The differential diagnosis included thrombus and endocardial fibroelastosis. (AVI 3603 kb)

Echodensity filling the left ventricle (see Fig. 14.3). Color Doppler demonstrated flow within the echodensity (small arrows) and highlighted deep crypts (large arrow). These morphological findings are consistent with non-compaction cardiomyopathy (AVI 1911 kb)

Apical mass (see Fig. 14.5). Zoomed view of the apex in the apical two-chamber view, demonstrating a large mass (arrow). It is well circumscribed with smooth borders and has an echotexture similar to that of the adjacent myocardium. As seen in the video, there is anterior apical and inferior hypokinesis. These findings suggest the mass is a thrombus (AVI 60472 kb)

Right atrial mass (see Fig. 14.6). Apical four-chamber view demonstrating a large, well-circumscribed mass in the right atrium prolapsing across the tricuspid valve (AVI 137817 kb)

Right atrial mass (see Fig. 14.6). Subcostal imaging demonstrated origin of the mass in the inferior vena cava (arrow). Pathology was consistent with carcinoid tumor (AVI 137817 kb)

271988_1_En_14_MOESM9_ESM.avi

Stress echocardiogram demonstrating ischemia (see Fig. 14.7). Comparison rest (upper left), stress (upper right), and recovery (lower left) two-chamber views during exercise stress echocardiography. The stress images demonstrate reduced ejection fraction with a mid to distal inferior wall motion abnormality, consistent with a significant right coronary artery stenosis. Recovery images demonstrate resolution of the wall motion abnormality (AVI 3319 kb)

271988_1_En_14_MOESM10_ESM.avi

Left ventricular assist device imaging (see Fig. 14.8). Parasternal long-axis view of a patient with a left ventricular assist device (LVAD) set at 9,400 rpm. The video demonstrates that the left ventricular (LV) ejection fraction is severely decreased (~10 %) and that there is no aortic valve opening. The inflow cannula of the LVAD is seen near the LV apex (arrow). It is normally positioned and is unlikely to be subject to any suction events, in which portions of the ventricle or the mitral apparatus are drawn into the opening of the cannula, obstructing flow. The septum is neutral between the LV and right ventricle (RV), indicating adequate LV decompression from LVAD function and suggesting that there is no RV volume or pressure overload (AVI 33967 kb)

Endocarditis (see Fig. 14.9). Parasternal long-axis zoomed view of the mitral valve demonstrating a very large, multilobulated and highly mobile echodensity on both sides and both leaflets of the mitral valve, consistent with endocarditis lesion (AVI 80160 kb)

(AVI 61879 kb)

(AVI 137817 kb)

Video 14.2a

Stress-induced cardiomyopathy (see Fig. 14.2). Apical four-chamber view demonstrates akinesis of the mid chamber to the apex, consistent with either multivessel coronary ischemia or stress-induced cardiomyopathy (Takotsubo). (AVI 7035 kb)

Video 14.6

Stress echocardiogram demonstrating ischemia (see Fig. 14.7). Comparison rest (upper left), stress (upper right), and recovery (lower left) two-chamber views during exercise stress echocardiography. The stress images demonstrate reduced ejection fraction with a mid to distal inferior wall motion abnormality, consistent with a significant right coronary artery stenosis. Recovery images demonstrate resolution of the wall motion abnormality (AVI 3319 kb)

Video 14.7

Left ventricular assist device imaging (see Fig. 14.8). Parasternal long-axis view of a patient with a left ventricular assist device (LVAD) set at 9,400 rpm. The video demonstrates that the left ventricular (LV) ejection fraction is severely decreased (~10 %) and that there is no aortic valve opening. The inflow cannula of the LVAD is seen near the LV apex (arrow). It is normally positioned and is unlikely to be subject to any suction events, in which portions of the ventricle or the mitral apparatus are drawn into the opening of the cannula, obstructing flow. The septum is neutral between the LV and right ventricle (RV), indicating adequate LV decompression from LVAD function and suggesting that there is no RV volume or pressure overload (AVI 33967 kb)

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Haines, P.G., Mehta, N., Kirkpatrick, J.N. (2014). Role of Echocardiography in Cardiology Consultation. In: Stergiopoulos, K., Brown, D. (eds) Evidence-Based Cardiology Consult. Springer, London. https://doi.org/10.1007/978-1-4471-4441-0_14

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  • DOI: https://doi.org/10.1007/978-1-4471-4441-0_14

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