Accurate, Reliable Echocardiography Saves Time, Money and Lives

Posted on 25 September 2018

Accurate and reliable cardiac imaging is the key to better patient outcomes, says Mediclinic Panorama cardiologist and echocardiographic expert Dr Pieter Rossouw.

Cardiac imaging is a crucial step in diagnosing and managing cardiovascular disease. Typically, a cardiologist or radiologist would capture images of the heart’s valves and function, and use them to diagnose forms of heart disease.

But in many cases, these procedures suffer from a lack of clinical reliability, which hinders accuracy and can have an effect on the outcome of a patient. Echocardiography is the answer, says Dr Pieter Rossouw, a cardiologist based at the Mediclinic Panorama specialist heart health clinic.

“Of all the modalities we have to look inside the heart, an echocardiogram is perhaps the most useful,” he says. “We are able to get a lot more information, quicker and more cost-effectively, than if we use other methods, such as a cardiac MRI or CT.”

An echocardiogram, commonly referred to as an echo, is essentially an ultrasound of the heart. It can give doctors a picture of the shape and size of a patient’s heart, while offering a close look inside, at the functioning of the chambers and valves as well.

However, an echocardiogram is only effective if it is accurate and reliable, and this is where expertise and experience come in.

An echo is a standard procedure that many doctors use to diagnose and manage their patients’ conditions. “A standard transthoracic echocardiogram is about as non-invasive as it gets,” says Dr Rossouw. “We will place a transducer on the chest and this will send sound waves through the chest.” A transoesophageal echocardiogram is slightly more complicated: the transducer is attached to a flexible tube and guided down the throat, to get a closer look at the heart.

“We use a probe when we need to,” he says. “If we can’t get a clear or detailed enough image from the inside, we will revert to a transesophageal procedure. Otherwise, this technique is also very useful when we need to plan and execute heart surgery.”

But not all doctors will read the same images the same way, says Dr Rossouw. Some cardiologists prefer not to conduct these tests themselves, while others do not rely on them, and have become unaccustomed in reading their results. How doctors use echocardiographic technology to capture and decode images of the heart can play a large role in how their patients are treated.

“Many cardiologists are not trained to conduct cardiac ultrasounds themselves,” says Dr Rossouw. “They may employ a technologist to do these tests, and we then see a lot of these doctors refer their patients to someone who is trained, or accustomed and experienced in reading echocardiograms.” This disconnect is not ideal for the patient, as his or her diagnosis or treatment is delayed in the process, often at an added expense.

“There are of course clear-cut, global, verified guidelines that determine, for example, how we read valve function of the ultrasound,” he says. “But sometimes those guidelines are not followed or applied as rigorously as they could be, and the doctor ends up getting a lot of different answers from different people. That can lead to, not necessarily a wrong decision, but a judgment based on a subjective opinion.”

Echocardiography can definitely help improve patient outcomes, by offering a more accurate picture, says Dr Rossouw. “Doctors have been trained in different ways; some of us have been taught to rely on cardiac ultrasounds, and others not. I rely on an echocardiogram to help my decision making, both in my diagnosis and management of a patient’s condition. It helps me understand what is wrong with the heart, and to follow up, to see if or how the treatment is working.”

Cardiologists who are not trained in the art of echocardiography may not have built up the same expertise in this field due to regular use. “You can do without it, but then you are dependent on critical findings and examinations, all of which takes time. So I believe you should rather rely on an echo than not because, in just a few minutes, you can get all the answers you need in a lot less time.”

Dr Rossouw believes echocardiography training as a more regular diagnostic tool could help doctors provide the care their patients need more effectively. And there are encouraging signs that what once a subspecialty is becoming a priority for medical students and a more regular part of cardiologists’ daily practice.

“We even see emergency physicians who are being trained to use an echo in the field,” says Dr Rossouw. “Say for instance a guy comes in with shortness of breath: with one probe you know immediately that he has an issue with a valve or pump function or a blood problem. This one test just makes your diagnostic process so much quicker – and you are then able to help him sooner and more effectively.”

The same is true inside a hospital. “It comes down to training – someone who is trained to rely on this test will naturally develop the expertise to use it effectively. Empowering cardiologists to use this test more regularly will help them treat their patients with a lot more accuracy.”