COCATS 4 Task Force 5: Training in Echocardiography

2019 ACC/AHA/ASE advanced training statement on echocardiography (revision of the 2003 ACC/AHA clinical competence statement on echocardiography)

“…These include complex congenital heart defects (both repaired and unrepaired), the full spectrum of acquired and genetic cardiomyopathies, and the various etiologies of cardiac masses. Competency in interpreting complex and postoperative congenital heart disease may require training beyond Level III . This additional training may occur at another site with a high volume of complex congenital heart disease.…”

“…To obtain Level III competency, the trainee must first fulfill the requirements for Level II certification and then gain additional experience in performing and interpreting both routine and specialized echocardiographic studies. Level III training should not only include acquiring expertise in the technical aspects of advanced echocardiographic imaging methods (such as 3D, strain, and contrast imaging), but should also provide a structured educational program that enables the trainee to best apply these methods in the treatment of specialized patient populations.…”

“…For adequate exposure to special procedures, advanced training should occur in a laboratory that is performing at least 7,500 studies annually . Level III training in special ultrasound procedures provides a full understanding of the principles, indications, risks, and technical limitations of the techniques.…”

“…Both the use of agitated saline contrast in the evaluation of patients with suspected right‐to‐left shunts and the use of microbubble contrast agents (ultrasound enhancing agents) for identification of endocardial borders and detection of intracardiac thrombi are considered standard requirements for Level II training in echocardiography . Level III training in contrast echocardiography should also include instruction on the chemical composition and physical properties of ultrasound enhancing agents, advanced ultrasound equipment settings, safety issues, and protocols for cardiac mass detection and characterization …”

“…Each COCATS 4 document includes individual Task Force reports that address subspecialty areas in cardiology, each of which is an important component in training a fellow in cardiovascular disease. The Task Force 5 report of that document addresses training in echocardiography and updates previous standards for general cardiovascular training for fellows enrolled in cardiovascular fellowship programs. It addresses faculty, facilities, and equipment.…”