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CARDIOLOGY www.healthcare-in-europe.com 15 When should this procedure be performed? Transthoracic echocardiography Posing the question of when tran- sthoracic echocardiography should be used, four senior figures in car- diac imagery examined its value in atrial fibrillation, chemotherapy, hypertension and stroke. Speaking in this session, Dr Dipak Kotecha, a clinician scientist in cardiovascular medicine at the University of Birmingham and con- sultant cardiologist specialising in cardiac imaging, said transthoracic echocardiography had a significant role to play in atrial fibrillation (AF). ‘AF,’ he said, ‘is becoming more prevalent and echo is important and essential in the patient management pathway. Incidence is expected to double in the next 20 years and by 2030 there will be 15-20 million people in Europe with AF. ‘We have to do echo in AF for ejection frac- tion but it is important for choos- ing what rhythm control drug you may use or whether it’s safe to use rhythm control in the first place. ‘Echo should be considered for all AF patients, as we are looking for LV function, risk of stroke, safety of rhythm control drugs and interven- tional support.’ Within hypertension Professor Jamil Mayet – who heads the Surgery, Cardiovascular and Cancer clinical, educational and research programmes at Imperial College Healthcare NHS Trust in London – outlined how transthoracic echo- cardiography can be used to try to support patients, to decide which ones receive treatment and for risk stratification. He explained that it can be used to assess whether there is left ven- tricular hypertrophy (LVH), diastolic dysfunction, LV systolic dysfunction, aortic valve issues or to assess myo- cardial ischemia. Concluding that transthoracic echocardiography has a role to play in hypertension, he said: ‘With patients who have stage one hyper- tension, we need to decide whether to treat the risk factors, lifestyle, or with drugs, and we can use echo if we are going to change the manage- ment of patients. ‘Patients who will benefit from referral for routine echocardiograph are those with borderline blood pressure, where LVH may have an influence on the decision to treat; possibility of white coat hyperten- sion; risk stratification in patients with multiple risk factors or routine reasons for echo, such as shortness of breath.’ Dr Leonard Shapiro, consult- ant structural interventionist at Papworth Hospital, Cambridge, sug- gested that the use of transthoracic echocardiography was not critical in all cases of stroke, but had value if it made a contribution to the manage- ment of patients. Dr Thomas Mathew, consult- ant cardiologist at Nottingham University Hospitals NHS Trust dis- cussed the role of transthoracic echocardiography in patients under- going chemotherapy in the context of cardio-toxicity. With patients suf- fering cellular destruction, biopsy changes, cumulative dose-related effects and permanent damage as a result of chemotherapy, echocardi- ography had a role in their assess- ment. ‘We should use the best form of echocardiography available and, on the evidence it is 3-DE as 2-DE fails to detect small changes in contractil- ity. If 2-DE has to be used, it should be with GLS or Troponin, which is the best biomarker in this context.’ Mathew is concerned that all heart failure trials have excluded patients with cancer and there are no proper studies in this evalua- tion group. ‘Using echocardiography is important,’ he underlined. ‘The main purpose is to decide whether to continue or stop chemotherapy because of the risk. Dr Dipak Kotecha MD is a clinician/ scientist in cardiovascular medicine at the University of Birmingham and a Consultant Cardiologist at Queen Elizabeth Hospital, Birmingham, specialising in cardiac imaging. An Honorary Research Fellow at the Royal Brompton Hospital, London, and the Monash University Centre of Cardiovascular Research & Education, Melbourne, he is a Task Force member for the European Society of Cardiology Guidelines on Atrial Fibrillation, and is currently writing the next set of practice guidelines that will be published in 2016. His main research interests are heart failure and atrial fibrillation. Dr Thomas Mathew is the clinical lead for cardiac imaging at Nottingham University Hospitals and specialises in echocardiography, cardiovascular magnetic resonance imaging and nuclear cardiology. He is also the training programme director for East Midlands North Deanery and a member of the BCS training committee. An elected council member of the British Society of Echocardiography and a member of the BSE educational committee, he is also an editorial board member of the British Journal of Echocardiography. With more than fifteen years’ experience in cardiovascular imaging, his interests include non-invasive imaging of ischaemic heart disease, valve assessments and cardiomyopathies. The role transthoracic echocardiography plays in a number of common clinical scenarios was discussed by leading cardiac imaging experts at this year’s British Cardiovascular Society Conference, Mark Nicholls reports. Copyright:Shutterstock/AlexanderRaths Now you can diagnose your patients faster. The better alternative to long-term ECG and event recorder. 1 2 For more information, visit www.cardiosecur.com or call +49 (0)69 - 907 477 81. 22-lead mobile ECG system using only 4 electrodes. Easy to use by patients, fits in every pocket. 43 Gives immediate alert if the heart condition changes. 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