A concise history of echocardiography: timeline, pioneers, and landmark publications.

Echocardiography is less than 70 years old, and many major advances have occurred within living memory, but already some pioneering contributions may be overlooked. In order to consider what circumstances have been common to the most successful innovations, we have studied and here provide a timeline and summary of the most important developments in transthoracic and transoesophageal ultrasound imaging and Doppler techniques, as well as in intravascular ultrasound and imaging in paediatric cardiology. The entries are linked to a comprehensive list of first publications and to a collection of first-hand historical accounts published by early investigators.

Sudden cardiac death: the pro-arrhythmic interaction of an acute loading with an underlying substrate.

Sudden cardiac death (SCD) is a complex phenomenon, occurring either in apparently normal individuals or in those where there is a recognized underlying cardiac abnormality. In both groups, the lethal arrhythmia has frequently been related to the physiologic trigger of either exercise or stress. Prior research into SCD has focused mainly on a combination of identifying either vulnerable myocardial substrates; pharmacological approaches to altering electrical activation/repolarisation in substrates; or the suppression of induced lethal arrhythmias with implantable defibrillators.

Ultrafast cardiac ultrasound imaging: technical principles, applications, and clinical benefits.

Several recent technical advances in cardiac ultrasound allow data to be acquired at a very high frame rate. Retrospective gating, plane/diverging wave imaging, and multiline transmit imaging all improve the temporal resolution of the conventional ultrasound system. The main drawback of such high frame rate data acquisition is that it typically has reduced image quality.

Severe myocardial impairment and chamber dysfunction in preterm preeclampsia.

Objective: The long-term cardiovascular risk of preeclampsia is known to be significantly higher in women requiring preterm delivery before 37 weeks compared with those delivered at term. The aim of this study is to assess and compare maternal cardiac function and geometry in acute preterm and term preeclampsia.

Methods: This is a prospective case-control study of 27 preterm and 50 term preeclampsia and 104 matched controls assessed by conventional echocardiography and tissue Doppler imaging.

Maternal cardiovascular impairment in pregnancies complicated by severe fetal growth restriction.

Fetal growth restriction and preeclampsia are both conditions of placental etiology and associated to increased risk for the long-term development of cardiovascular disease in the mother. At presentation, preeclampsia is associated with maternal global diastolic dysfunction, which is determined, at least in part, by increased afterload and myocardial stiffness. The aim of this study is to test the hypothesis that women with normotensive fetal growth-restricted pregnancies also exhibit global diastolic dysfunction.

Persistent dysfunction of viable myocardium after revascularization in chronic ischaemic heart disease: implications for dobutamine stress echocardiography with longitudinal systolic strain and strain rate measurements.

Aims: Studies of functional recovery after revascularization in chronic coronary artery disease are contradictory and mark a lack of knowledge of persistent dysfunction in the non-scarred myocardium. Based on tissue Doppler-derived regional longitudinal systolic strain and strain rate (SR), both at rest and during dobutamine stress (DS), we assessed to what extent ischaemia-related reduced myocardial function would recover after revascularization in hearts with predominantly viable myocardium.

Methods And Results: Reference peak systolic strain and SR values were determined from tissue Doppler imaging in 15 healthy volunteers.

Preeclampsia is associated with persistent postpartum cardiovascular impairment.

Preeclampsia is associated with asymptomatic global left ventricular abnormal function and geometry during the acute phase of the disorder. These subclinical abnormalities in cardiac findings are known to be important in cardiovascular risk stratification for nonpregnant patients. Furthermore, epidemiological studies have also demonstrated a relationship between preeclampsia and cardiac morbidity and mortality later in life.

Impaired biventricular deformation in Marfan syndrome: a strain and strain rate study in adult unoperated patients.

Objective: To investigate the presence of any regional myocardial deformation abnormalities in Marfan syndrome (MFS) and determine the benefits of using advanced echocardiography compared to conventional techniques.

Background: Myocardial dysfunction in MFS may be caused by extracellular matrix remodeling thus, resulting in uniform reduced functionality. However, increased aortic stiffness may cause segmental ventricular abnormalities.

Prediction of postoperative left ventricular systolic function in patients with chronic mitral regurgitation undergoing valve surgery--the role of deformation imaging.

Objective: Preoperative left ventricular systolic function is an important prognostic factor in patients undergoing mitral valve surgery. Preoperative myocardial deformation may be impaired without reduction in conventional indices such as ejection fraction (EF). Strain rate (SR) imaging is very sensitive in detecting regional systolic abnormalities and might allow diagnosis of subclinical changes in systolic left ventricular (LV) function before surgery.

Assessment of aortic stiffness in marfan syndrome using two-dimensional and Doppler echocardiography.

Background: Extracellular matrix remodeling in the aortic wall results in increased aortic stiffness (AoS) in Marfan syndrome (MFS). Pulsed-wave velocity (PWV) constitutes the best indirect AoS measurement. We aimed to assess PWV in MFS patients using two-dimensional (2D) and Doppler echocardiography.

Effect of aortic stiffness on left ventricular long-axis systolic function in adults with Marfan syndrome.

Introduction: several studies have documented increased aortic stiffness in patients with Marfan syndrome (MFS) using echocardiography and magnetic resonance imaging. Recent studies have also shown primary myocardial impairment in MFS. We investigated whether left ventricular (LV) function could be further impaired when acting against a stiff vascular system.

Maternal cardiac dysfunction and remodeling in women with preeclampsia at term.

Preeclampsia is a disease associated with significant cardiovascular morbidity during pregnancy and in later life. This study was designed to evaluate cardiac function and remodeling in preeclampsia occurring at term. This was a prospective case-control study of 50 term preeclampsia and 50 normal pregnancies assessed by echocardiography and tissue Doppler analysis.

Successful ablation for atrioventricular nodal reentrant tachycardia in a patient with left atrial isomerism.

Left atrial isomerism (LAI) is characterized by the presence of two morphologically identical atria. It is commonly associated with conduction defects. We report a case of LAI presenting with highly symptomatic atrioventricular nodal reentrant tachycardia, which was cured by ablation.

The role of echocardiographic deformation imaging in hypertrophic myopathies.

Echocardiography has a leading role in the routine assessment and diagnosis of hypertrophic ventricles. However, the use of M-mode echocardiography and measurement of global left ventricular function may be misleading. Traditionally, systolic function was thought to be preserved in patients with hypertrophic myopathies until the late stages of the disease, and hypertrophic myopathies were thought to affect the myocardium more diffusely than ischemic heart disease.

Sequential changes of longitudinal and radial myocardial deformation indices in the healthy neonate heart.

Background: Significant hemodynamic changes, including preload and afterload modifications, occur during the transition from the fetal to the neonatal environment. The ductus arteriosus closes, pulmonary vascular resistance decreases, and pulmonary blood flow increases. Strain rate (SR) and strain (epsilon) have been proposed as ultrasound indices for quantifying regional wall deformation.

Biventricular and atrial diastolic function assessment using conventional echocardiography and tissue-Doppler imaging in adults with Marfan syndrome.

Aims: Previous studies provided evidence about left ventricular systolic and diastolic dysfunction in adults with Marfan syndrome (MFS). However, in the literature, data on right ventricular and bi-atrial diastolic function are limited. We aimed to investigate whether, in the absence of significant valvular disease, diastolic dysfunction is present not only in both ventricles but also in the atrial cavities.

How to detect early left atrial remodelling and dysfunction in mild-to-moderate hypertension.

Background And Objectives: Early changes in left atrial function in hypertension are difficult to assess quantitatively. Measuring atrial reversal flow into the pulmonary veins and regional left atrial deformation parameters assessed by Tissue Doppler-derived strain/rate (S/SR) imaging could provide quantitative assessment of left atrial deformation. We aimed to quantify changes in left atrial volume and deformation and pulmonary flow reversal (PVREVERS) in hypertension to detect subclinical left atrial dysfunction.

Low-dose dobutamine stress echo to quantify the degree of remodelling after cardiac resynchronization therapy.

Aims: Presence of contractile reserve during low-dose dobutamine stress echo (DSE) appears predictive of cardiac resynchronization therapy (CRT) outcome. We hypothesize that changes in left bundle branch block (LBBB)-induced dyssynchronous motion during low-dose DSE could be related to the extent of reverse remodelling.

Methods And Results: Fifty-two patients (69 +/- 2 years, EF: 24 +/- 7%, QRS > 120 ms) were studied pre- and post-CRT (7 +/- 1 months).

Quantification of regional left and right ventricular deformation indices in healthy neonates by using strain rate and strain imaging.

Background: Color Doppler myocardial imaging (CDMI) allows the calculation of local longitudinal or radial strain rate (SR) and strain (epsilon). The aims of this study were to determine the feasibility and reproducibility of longitudinal and radial SR and epsilon in neonates during the first hours of life and to establish reference values.

Methods: Data were obtained from 55 healthy neonates (29 male; mean age, 20 +/- 14 hours; mean birth weight, 3,174 +/- 374 g).

Myocardial stunning identified by using strain/strain rate imaging during dobutamine stress echocardiography in a rare late recurrence of Tako-Tsubo syndrome.

Tako-Tsubo cardiomyopathy affects postmenopausal women and is often associated to emotional or physical stress. It is typically characterized by transient left ventricular apical ballooning with chest pain and, electrocardiographic changes and biochemical markers suggestive of acute coronary syndrome, despite angiographically normal coronary arteriograms. The pathogenesis of the condition is still unknown, but increased catecholamine levels have been postulated as a pathogenic mechanism.

Velocity and deformation imaging for the assessment of myocardial dysfunction.

Recent developments in echocardiographic imaging technology and processing enabled the quantification of myocardial motion and deformation in a clinical setting. Echocardiographic strain (-rate) imaging provides a relatively easy way to study myocardial deformation. However, although (local) deformation is clearly linked to cardiac (dys-) function, it is important to understand how this information can be used in clinical practice and how specific deformation patterns should be interpreted.

Assessment of carotid compliance using real time vascular ultrasound image analysis in Marfan syndrome.

Background: Fibrillin-1 deficiency, dysregulated cytokine transforming growth factor-beta, and increased collagen deposition related to fibrillin-1 gene mutations could predispose to impaired carotid compliance (CC) in Marfan syndrome (MFS). We sought to detect any alterations in CC using the vascular image analysis system (VIA).

Methods And Results: Thirty-two MFS patients, 20 men and 12 women (mean age 34.

Toward understanding response to cardiac resynchronization therapy: left ventricular dyssynchrony is only one of multiple mechanisms.

Aim: To date, most published echocardiographic methods have assessed left ventricular (LV) dyssynchrony (DYS) alone as a predictor for response to cardiac resynchronization therapy (CRT). We hypothesized that the response is instead dictated by multiple correctable factors.

Methods And Results: A total of 161 patients (66 +/- 10 years, EF 24 +/- 6%, QRS > 120 ms) were investigated pre- and post-CRT (median of 6 months).