A practical guideline for performing a comprehensive transthoracic echocardiogram in adults: the British Society of Echocardiography minimum dataset

Abstract

Since cardiac ultrasound was introduced into medical practice around the middle twentieth century, transthoracic echocardiography has developed to become a highly sophisticated and widely performed cardiac imaging modality in the diagnosis of heart disease1. This evolution from an emerging technique with limited application, into a complex modality capable of detailed cardiac assessment has been driven by technological innovations that have both refined ‘standard’ two dimensional and Doppler imaging and led to the development of new diagnostic techniques. Accordingly, the adult transthoracic echocardiogram has evolved to become a comprehensive assessment of complex cardiac anatomy, function and haemodynamics. This guideline protocol from the British Society of Echocardiography aims to outline the minimum dataset required to confirm normal cardiac structure and function when performing a comprehensive standard adult echocardiogram and is structured according to the recommended sequence of acquisition. It is recommended that this structured approach to image acquisition and measurement protocol forms the basis of every standard adult transthoracic echocardiogram. However, when pathology is detected and further analysis becomes necessary, views and measurements in addition to the minimum dataset are required and should be taken with reference to the appropriate British Society of Echocardiography imaging protocol. It is anticipated that the recommendations made within this guideline will help standardise the local, regional and national practice of echocardiography, in addition to minimising the inter and intra-observer variation associated with echocardiographic measurement and interpretation.

Echocardiographic assessment of aortic stenosis: a practical guideline from the British Society of Echocardiography

“…The primary focus should be toward optimization of the echocardiographic assessment and classifying the severity of AS, before identifying any high-risk characteristics. All patients should undergo a comprehensive echocardiographic assessment according to the principles of the minimum dataset 3 .…”

“…In all patients with aortic valve disease, it is imperative that they undergo a complete and careful echocardiographic evaluation, according to the principles of the minimum dataset ( 3 ). The specific windows and images required for the echocardiographic assessment of AS are described in Table 2 followed by a suggested reporting template in Table 3 .…”

“…LVMi should be estimated using the linear method from the parasternal long-axis window and indexed to BSA ( 3 ).…”

“…The primary focus should be towards optimization of the echocardiographic assessment and classifying the severity of AS, before identifying any high-risk characteristics. All patients should undergo a comprehensive echocardiographic assessment according to the principles of the minimum dataset ( 3 ). Whilst the classical echocardiographic features of amyloid may not be specific for the disease in patients with severe AS, when aortic stenosis is mild or even moderate, the usual echocardiographic approach for identifying infiltrative disease is appropriate.…”

“…This guide should be seen as supplementary to the BSE minimum dataset ( 3 ). The intended benefit of this supplementary document is to:…”