Echocardiography is a non-invasive test that uses ultrasound waves to create moving pictures of the heart. It is the most commonly ordered test to evaluate heart structure and function. Doppler assessment allows for measurement of the velocity of blood flow across the heart valves and thereby evaluates their function.
At Lahey Hospital & Medical Center, our state-of-the-art Echocardiography Lab provides 2D imaging to assess heart and valve function in real time, and 3-D live imaging when needed to help identify a heart problem more precisely and guide the best treatment for each patient.
Our cardiovascular medicine specialists perform echocardiography to:
- Evaluation of cardiac chamber size and function
- Assess regional and global contractile function of the pumping heart chambers (left and right ventricles)
- Detect, and quantify severity of valve dysfunction (narrowing or leakage)
- Estimate pressures within the various heart chambers and within the pulmonary artery
- Detect possible congenital abnormalities such as a “hole in the heart”
- Detect possible blood clots inside the heart
- Assess pericardium (the sac around the heart) for evidence of fluid buildup (pericardial effusion), or abnormal thickening (pericardial constriction)
- Identify problems with the aorta, the main artery that carries oxygen-rich blood from your heart to the rest of your body
Various modalities are utilized at the Echocardiography Lab, including:
Transthoracic Echocardiography: This is the most commonly used modality where the ultrasound transducer is placed on the chest to obtain surface images from various acoustic windows.
The images below shows cross sections of the main pumping chamber (the left ventricle) showing normal regional contractility pattern (typically assessed in a moving image format) of all segments visualized at three standard imaging levels.
Spectral Doppler: This modality is used to determine direction and speed of blood flow within the heart chambers and across heart valves. It is commonly used to detect valvular narrowing abnormalities (stenosis), and grade its severity.
The Doppler example below shows how Doppler measurements can be combined with 2D imaging for the calculation of stroke volume, cardiac output, and valve area quantification.
The Spectral Doppler below shows high intracardiac flow velocity (within the left ventricle) caused by obstruction to flow from abnormal thickening of the heart muscle in a patient with hypertrophic cardiomyopathy)
Color Doppler: This modality is used in conjunction to 2D imaging to determine direction and speed of blood flow within the heart chambers. It is particularly useful for detection and estimation of severity of valve regurgitation (leakage).
The images below show a normal thoracic aorta and related structures. The image on the left illustrates a normal aortic size and branching of the great vessels. The image on the right shows a normal color Doppler pattern of flow within the thoracic aorta.
Stress Echocardiography: This is a commonly used modality for the non-invasive detection of “ischemia,” a condition whereby there is compromise in blood flow during stress related to atherosclerotic plaque that causes partial narrowing of a coronary vessel. This results in the consumption of oxygen by heart muscle tissue at a rate that is greater than can be delivered to it, causing it to contract less effectively than a neighboring heart muscle segment that is supplied by a healthy vessel without narrowing. Such a difference in contractility pattern is detectable by echocardiographic imaging.
Stress is typically achieved with exercise, but for those who are unable to adequately perform an exercise based stress test, pharmacologic testing with dobutamine can be alternatively used. The data obtained from such stress tests, which are obtained non-invasively and without radiation, are then used for planning the best treatment strategy in an individual patient, and to decide on whether additional testing and/or treatment is required.
The images below are still pictures of moving images that illustrate a typical quad screen display format of a tress Echocardiogram. All images are digitized and displayed to allow direct comparison in contractility between analogous segments at rest (2 images on the left) and the same segments at peak stress (the 2 images on the right).
Transesophageal Echocardiography (TEE): This advanced imaging study allows for acquisition of higher resolution images from the esophagus (the tube that connects the mouth with the stomach). Various cardiac structures can be better assessed with this modality (such as the left atrial appendage imaged below). It is commonly used for echocardiographic guidance during interventional procedures.
The TEE image below shows the left atrium, and a measurement of the left atrial appendage for sizing of a Watchman closure device before its implantation.
The image below is from a patient with an atrial septal defect, a “hole in the heart” that causes abnormal flow across the septal partition that separates the left and right atria, as illustrated by the blue color signal below.
3-Dimentional (3D) Echocardiography: 3D Echocardiography is utilized in selected cases where the live three dimensional display of cardiac structures and their relationship to one another is important for decision-making. This is particularly common during interventional procedures.
The 3D image below shoes a large atrial septal defect (dark oval appearance in left image), and an en face view of the device that was used to close it (image on the right).
The echocardiography laboratory plays a central role in the diagnosis of a wide variety of cardiovascular conditions in the ambulatory, inpatient, critical care, and intraoperative settings. The echocardiography laboratory at the Lahey Hospital &Medical Center is a high volume laboratory where the team performs more than 18,000 echocardiograms annually. This includes over 4,000 stress echocardiograms (exercise and dobutamine stress), which represents one of the largest stress echo volumes in the New England area.
The echo lab is fully accredited through Intersocietal Accreditation Commission (IAC), which is the only recognized body that that sets national quality standards and accredits laboratories after a rigorous review. All of the echo machines have live 3D capability, and the reading stations include the capability for advanced off-line analysis and quantification.
The Lahey Cardiovascular Department strives to provide cutting-edge techniques using the latest emerging technologies to its patients. Successful performance of many such procedures is critically dependent on image-guided interventional procedures. This has led to an era of deeper collaboration with the invasive cardiology specialties.
Specifically, with the development of new services in the Arrhythmia Section regarding closure of the left atrial appendage, and in Interventional Cardiology with the Transcatheter Aortic Valve Replacement (TAVR), and percutaneous procedures for mitral regurgitation (MitraClip), our commitment to supporting invasive procedures has taken a quantum leap.
When we combine these important clinical enhancements with the growth in demand for diagnostic studies, we anticipate that the Lab will continue to provide the necessary support to offer the best service possible for our outpatients, inpatients and patients undergoing advanced cardiac procedures.
Meet The Echocardiography Team
- Sherif B. Labib, MD Director, Echocardiography Laboratories
- Paula Kinnunen, MD , Director, LHMC Women’s Cardiovascular Health Program
- Darryl D. Esakof, MD, Director Cardiovascular Informatics and Non-Invasive Testing
- Danya Dinwoody, MD
- Jennifer Collins, MD
- Stephen Schwartz, MD
- David Venesy, MD, Director, LHMC Advanced Heart Failure Program
- Sachin Shah, MD, Medical Director, Coronary Care Unit
- Richard Patten, MD, Director, Lahey Health Integrated Heart Failure Network
- Timothy Draper, DO, Medical Director, Lahey-Peabody Cardiology
- Jeffrey Clayman, MD
- Jana Montgomery, MD, MPH, Director, LHMC Anticoagulation Services
- Robin Childress, PA