Cohen A
Service de cardiologie, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75571 Paris.
Arch Mal Coeur Vaiss. 2001 Jan;94 Spec No 1:27-39.
The advances in Doppler echocardiography, like last year, concern the technology, the indications and the description of the natural history of cardiovascular diseases. The year 2000 will be remembered for the development of portable echocardiographs with two-dimensional and Doppler capabilities but without M mode, pulsed or continuous Doppler. These instruments weigh less than 3 kg and may be used at the bedside; however, problems of training personnel, reimbursement and availability of equipment remain. Myocardial contrast echocardiography has been the subject of many publications which validate continuous intravenous infusion of different contrast agents, which, coupled with techniques of image processing, suggest that quantification of regional myocardial perfusion at rest or during physiological or pharmacological stress may not be far off. The indications of stress echocardiography have increased: in addition to diagnostic and prognostic information in coronary artery disease, the applications of exercise and pharmacological inotropic stress echo extend to asymptomatic valvular regurgitation to detect infraclinical myocardial dysfunction before the usual Doppler echocardiographic parameters show significant changes. The value of Doppler tissue imaging in the assessment of regional myocardial function has been demonstrated: analysis of diastolic function with pulsed Doppler at the mitral annulus, quantification of regional myocardial function in different pathologies such as ischaemic heart disease and cardiomyopathy, validation of indices during stress echocardiography with the hope of a quantitative as well as a qualitative assessment, much improved since the introduction of harmonic imaging. Finally, Doppler haemodynamic evaluation has continued to substitute for cardiac catheterisation, now providing accurate indices of quantification of valvular regurgitation and description of the natural history of cardiac diseases, especially mitral regurgitation irrespective of its cause and aortic stenosis including cases with low output states. The continuing progress of ultrasound technology is therefore confirmed and provides an outlook into the third millennium: development of portable equipment, improved probe technology, use of instruments of quantification and extension of real time three-dimensional reconstruction, systems of image stocking and transmission and better orientation of its usage with the recommendations of scientific societies.
与去年一样，多普勒超声心动图的进展涉及技术、适应证以及心血管疾病自然史的描述。2000年将因便携式超声心动图仪的发展而被铭记，这种仪器具备二维和多普勒功能，但没有M型、脉冲或连续多普勒功能。这些仪器重量不足3千克，可在床边使用；然而，人员培训、报销以及设备可用性等问题依然存在。心肌对比超声心动图已成为众多出版物的主题，这些出版物证实了不同造影剂的持续静脉输注，再结合图像处理技术，表明静息状态下或生理或药理应激期间区域心肌灌注的量化或许为期不远。负荷超声心动图的适应证有所增加：除了冠状动脉疾病的诊断和预后信息外，运动和药物性正性肌力负荷超声心动图的应用扩展到无症状瓣膜反流，以在常规多普勒超声心动图参数显示明显变化之前检测亚临床心肌功能障碍。多普勒组织成像在评估区域心肌功能方面的价值已得到证实：通过二尖瓣环处的脉冲多普勒分析舒张功能，量化不同病理状态（如缺血性心脏病和心肌病）下的区域心肌功能，在负荷超声心动图期间验证各项指标，以期进行定量和定性评估，自谐波成像引入以来有了很大改进。最后，多普勒血流动力学评估继续替代心导管检查，现在能够提供准确的瓣膜反流定量指标，并描述心脏病的自然史，尤其是二尖瓣反流，无论其病因如何，以及主动脉瓣狭窄，包括低心输出量状态的病例。因此，超声技术的持续进步得到了证实，并为第三个千年提供了展望：便携式设备的开发、探头技术的改进、定量仪器的使用以及实时三维重建的扩展、图像存储和传输系统，以及根据科学协会的建议更好地确定其使用方向。
