Recent advances in non-invasive cardiology

Editor—The recent review of advances in non-invasive cardiology by Prasad et al does not discuss echocardiography except briefly as an electronic addendum.¹ A striking omission is three dimensional echocardiography, which has advantages over two dimensional echocardiography in assessing left ventricular volumes and synchrony and for congenital disease and mitral valve disease.² Miniaturisation of machines now allows studies to be conducted anywhere,³ so that echocardiography is increasingly being adopted by non-cardiologists. Stress echocardiography has repeatedly been validated for the prediction of coronary stenoses and for stratifying risk and is gaining in use (cardiac workforce requirements in the UK, www.BCS.com).⁴ A fuller account of advances in echocardiography is available.⁵

No competition should occur between different imaging modalities, and the most appropriate option should be used for any particular clinical indication. Echocardiography will always remain essential for the investigation of acutely ill patients since it is portable. Most district hospitals perform 3000-5000 studies each year, and national workforce planning indicates the need for 11-15 echocardiography consultants per million population compared with 2.9 per million for nuclear medicine and 1 per million for magnetic resonance (cardiac workforce requirements in the UK, www.BCS.com).

Figure 1.

Credit: BULLETTE AND THEROUX/SPL

We are concerned that this article could lead health service managers to eschew the relatively inexpensive, effective, safe and widely available echocardiographic techniques for the apparently more alluring, more expensive techniques of magnetic resonance and cardiac computed tomography. All have developing roles either in clinical practice or research, and it is important that they are viewed in proper perspective.