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Cardiac imaging 

Cardiac imaging
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date: 17 June 2021

It is difficult to imagine how much echocardiography has evolved since the first recordings of movement of the mitral valve were made by Edler and Hertz in Sweden in the 1950s. Since that time ultrasound technology has grown so much that it's difficult to appreciate that the detailed, real-time 3D cardiac images we can obtain today are based upon the same basic principle that those pioneers used 50 years ago. As the technology has improved, the range of clinical applications of echo has also increased and now it is one of the most widely used diagnostic techniques for the assessment of cardiac pathology in both adults and children.

The technological advances in echocardiography have included progression from basic, single-dimensional recordings of individual cardiac structures to real-time 3D dimensional imaging of the entire heart. Improvements in transducer technology, computer processing power, and digital image processing/storage have made these advances possible. Image quality and resolution have also improved with the advent of the transoesophageal approach (in selected patients), harmonic imaging and the use of contrast agents. Thanks to these advances, echo has now become the first-line technique for the assessment of left ventricular function, the evaluation of valvular heart disease and the diagnosis of congenital heart disease. In addition, it has evolved as a pivotal diagnostic technique in the assessment of patients with suspected endocarditis, cardio-embolic stroke, and in the functional assessment of coronary artery disease. More recently, the technique has been increasingly used to guide interventional procedures for structural heart disease.

Most of the landmark papers chosen for this section have been included because they represent either the first or the most widely quoted publications that marked a significant step forward in the development of echocardiography. Every single paper demonstrates an important and, in the authors’ opinions, pivotal advance in technology and/or clinical application of this most pervasive of all cardiac diagnostic techniques.

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