[The best of echocardiography in 2002].

The role of echocardiography in cardiology practice continues to increase both in the everyday evaluation of patients and in the field of research. Nearly 3500 bibliographic references on the subject were available in 2002... The advances achieved during one year often seem modest but reviewing the last 3 to 5 years, the progress of this method in clinical management has been significant. 2002 will be remembered as the year in which 3D echocardiography, a technical revolution, became a routine tool. The matricial transducer generating a conic ultrasound beam from 3000 crystals allows routine visualisation of the heart in movement in three dimensions. In Doppler tissue imaging, the publications guide usage of this mode for identifying myocardial deformation during the cardiac cycle rather than simple abnormalities of wall motion as in initial experiences. Promising experimental results must be validated in clinical usage for this to become an everyday tool or analysis of regional myocardial contractility. A pioneer publication of clinical validation versus MRI showed excellent correlations both for healthy and abnormal myocardial segments. Contrast echocardiography has benefited from the introduction of new contrast agents tested in animals and new methods of image processing. It can be used in clinical practice to evaluate left ventricular function in difficult patients (chamber opacification). Semi-quantitative evaluation of myocardial perfusion by the transthoracic approach remains a field of research for expert centres in France. Finally, investigation of patients to determine the cause of systemic embolism has made additional progress as teams using harmonic imaging have identified high risk plaques of atheroma in over 90% of cases.