par Sridhar Nadamuni
, Contributing Reporter | March 07, 2017
From the March 2017 issue of HealthCare Business News magazine
Dr. Cullen still subscribes to his finding reported in the Mayo Clinical Proceedings of June 2014 that “hand-held echocardiography (HHE) tends to underestimate rather than overestimate the severity of abnormal findings,” suggesting that, “HHE should not be used as a surrogate for TTE.” In addition to TTE, stress echocardiography used to unravel cardiac muscle function, 3-D echocardiography and left ventricular strain measurement are driving the market size.
According to Dr. Mulvagh, “the use of echocardiography to guide cancer [assessing chemotherapy or radiation damage to the heart] treatments has also opened a new avenue of diagnosis and encouraged the use of strain echocardiography.”
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“Using strain imaging and 3-D echo on patients receiving chemotherapy can identify those at risk for cardiotoxicity, and their prognosis could improve by close collaborative monitoring by cardiologist and oncologist and initiation of cardioprotective medications,” says Dr. Kort. However, the procedure is “operatordependent [technical skill of the person using the probe and recording the images is variable] and reading cardiac ultrasounds requires a technically advanced skill set,” says Dr. Mulvagh.
“The other disadvantage of echocardiography is that images of tortuous structures such as blood vessels in the path of the ultrasound beam may be distorted and yield wrong measurements resulting in an inaccurate estimate of the dimensions,” says Dr. Desai. The 3-D echo is a refined version that overcomes the issues related to tangential measurements, but is still dependent on the 2-D echo, Dr. Desai adds. He also highlighted the appropriate use of contrast echocardiography, for example, in patients that are difficult to image such as smokers and obese patients.
It is recommended for 10 percent to 15 percent of all cases. As Dr. Cullen observed, echocardiography is incapable of providing anatomical detail to the same extent as a CT scan or cardiac MRI. “Muscle perfusion is also not as clear as in nuclear MRI.” Echocardiography is not a stand-alone modality, but an adjunct to other procedures, he added. Dr. Desai’s main concern relates to the potential abuse of HHU devices. “As with any new device, there is a risk of overuse or inappropriate use that could raise the health care costs,” Desai said.
It might be appropriate as a point-of-care intervention for rapid diagnosis in an emergency such as pericardial tamponade or a patient with severe chest pain with fluid build-up despite normal ECG findings. However, “physicians and technicians at corporate hospitals may have a tendency to abuse the modality just to make a fast buck at the expense of the patient, which is undesirable.”