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ASE releases new guidelines for echocardiography
New guidelines published by the American Society of Echocardiography aim to help physicians in their choices and use of the imaging technology.
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The guidelines contain data from numerous studies and focus specifically on the modalities of transthoracic, transesophageal and intracardiac echocardiography. The document was created to assist physicians in their selection of the modalities, and also to highlight their potential advantages when used during certain percutaneous procedures.
“There are a lot of different modalities and technologies out there,” Frank E. Silvestry, MD, an associate professor of medicine at the University of Pennsylvania Hospital in Philadelphia and co-chair of the guideline writing committee, told Cardiology Today. “Some of it may be a bit confusing, so we wanted to take a hard and careful look at the literature to see which of these modalities have proven roles and which have potential roles.”
The guidelines include information on the use of echocardiography for such procedures as transatrial septal catheterization, pericardiocentesis, myocardial biopsy, cardiac electrophysiology, percutaneous transvenous balloon valvuloplasty and several others. Angiographic and fluoroscopic guidance have traditionally been used to guide percutaneous coronary interventions but have been limited when the interventions involved the myocardium, pericardium and cardiac valves, according to the authors.
The document concentrated primarily on three echocardiographic modalities. Transthoracic echocardiography, according to the researchers, has been widely used in the guidance of PCI and in electrophysiologic procedures while transesophageal echocardiography offers superior image resolution compared with transthoracic echocardiography, and is valuable for assessing intraprocedural anatomy and physiology, monitoring catheter positioning and at excluding thrombus and other complications. Intracardiac echocardiography, which is described as a more recent application of cardiac ultrasound, is used for radio frequency ablation of AF, as well as transcatheter atrial septal closure.
“As the procedures that we are doing in the catheter and electrophysiology lab are getting more complex, we are going to rely upon imaging more and more to help guide these procedures,” Silvestry said. “...[A]ll cardiologists need to be familiar with how to use those modalities.”
Silvestry F. J Am Soc Echocardiogr. 2009;22:213-231.