New ultrasound technologies for quantitative assessment of left ventricular function

Abstract

Unfortunately, there is no easy solution to the continuing need to quantify regional function - the problem being complicated by issues of translational motion, tethering, torsional movements, image quality, and so on. All quantitative methods have at best matched but never outperformed the accuracy and reproducibility of qualitative expert reading for stress echocardiography. They have been shown to help the less expert reader, but should be considered a means of diagnostic support rather than a replacement for expert training. However, in routine work, reading by a trained observer remains the best, and only, way to diagnose wall motion abnormalities during stress echocardiography performed in the clinical arena. As summarized by the American Society of Echocardiography and European Association of Echocardiography recommendations, visual assessment of left ventricular wall thickening and motion remains the standard method of interpretation of stress echocardiography albeit with relevant interobserver and interinstitutional variability. In contrast, under resting conditions, the quantitative approach can offer obvious advantages when compared with standard eyeballing analysis for the detection of changes in longitudinal, circumferential, and radial function (e.g., in the serial assessment of changes induced by cardiotoxic interventions such as chemotherapy). The attempt as old as echocardiography itself to translate the wall motion abnormality from an opinion into a number remains a dream for the clinical cardiologist and a nightmare for the researcher. Maintenance of a critical attitude by the clinical cardiologist and sonographer in the face of the forest of new technologies proposed every year by the manufacturers is essential. © 2009 Springer Berlin Heidelberg.