ECHOCARDIOGRAPHY IN ISCHEMIC HEART-DISEASE - PRESENT STATUS AND FUTURE PROSPECTIVES

The initial general enthusiasm for echocardiography as a relatively simple and inexpensive noninvasive technique led to uncritical acceptance of some of its proposed applications. Patients with ischemic heart disease have proven to be difficult to evaluate echographically by usual techniques because the areas of the left ventricle which are visualized may not be representative. Thus, volume determinations and most indices of contractile performance, while frequently providing helpful qualitative information, have not been reliable in these patients. Useful information about segmental wall motion abnormalities can be obtained from the echocardiogram when the involved areas can be visualized, but much of the ventricle is not routinely examined. The role of ultrasound in patients with uncomplicated acute infarction remains predominantly investigational, but ultrasound may be helpful in the evaluation of patients with complications of infarction or those who may concomitantly have other forms of cardiac disease. Although much work continues with M-mode echocardiography, the development of twodimensional real-time ultrasonic equipment has added new impetus to the use of echocardiography in patients with coronary artery disease. These instruments can visualize most, if not all, of the left ventricle, and therefore are not subject to the inaccuracies inherent in evaluating M-mode echocardiograms in patients affected by a segmental disease. Several production models are currently available, and many improvements in instrumentation can be anticipated. Initial experience with two-dimensional echocardiography suggests that it is a valuable clinical and investigational tool, but the relatively high cost of the present equipment may retard wide dissemination of this promising technique. © 1978.