Echocardiography in coronary artery disease

Abstract

CHOCARDIOGRAPHY was introduced as a viable technique for evaluating anatomic heart disease in the late 1960s. Its earliest application involved detection of pericardial effusion and was soon followed by evaluation of valvular heart disease, most notably mitral stenosis. Its application in patients with coronary disease lagged substantially because of limitations of the earlier M-mode technique, which provided only a limited interrogation of the left ventricle, without the spatial orientation required for accurate diagnosis of wall motion abnormalities. With the introduction of clinical two-dimensional echocardiography in the late 1970s the ability to visualize all regions of the left ventricle, and to detect abnormal wall motion associated with myocardial ischemia or infarction was augmented tremendously. Subsequently, the technique began to see use in patients with known or suspected coronary disease. Initially, its use for this purpose was not widespread because of limitations of the narrow angle of the early scanners and sub-optimal image quality. With the development of newer generation imaging equipment, two-dimensional echocardiography now offers an unparalleled view of left ventricular anatomy and provides a simultaneous assessment of endocardial wall motion and myocardial thickening. Its tremendous versatility, relatively low cost, portability, and high degree of accuracy, make it an ideal tool in experienced hands for evaluating patients with known or suspected coronary disease. This includes patients with acute myocardial infarction, stable nonexertional chest pain syndromes, and chronic complications of myocardial ischemia. In this article the echocardiographic findings on which the diagnosis of coronary disease is made and many of the specific application in patients with coronary artery disease will be reviewed. Some of the newer, more specialized applications such as exercise echocardiography, direct coronary visualization, tissue characterization, and assessment of myocardial perfusion will also be discussed.