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Allan Harkness, Liam Ring, Daniel X Augustine, David Oxborough, Shaun Robinson, Vishal Sharma, and the Education Committee of the British Society of Echocardiography

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Abbas Zaidi, Daniel S Knight, Daniel X Augustine, Allan Harkness, David Oxborough, Keith Pearce, Liam Ring, Shaun Robinson, Martin Stout, James Willis, Vishal Sharma, and the Education Committee of the British Society of Echocardiography

The structure and function of the right side of the heart is influenced by a wide range of physiological and pathological conditions. Quantification of right heart parameters is important in a variety of clinical scenarios including diagnosis, prognostication, and monitoring response to therapy. Although echocardiography remains the first-line imaging investigation for right heart assessment, published guidance is relatively sparse in comparison to that for the left ventricle. This guideline document from the British Society of Echocardiography describes the principles and practical aspects of right heart assessment by echocardiography, including quantification of chamber dimensions and function, as well as assessment of valvular function. While cut-off values for normality are included, a disease-oriented approach is advocated due to the considerable heterogeneity of structural and functional changes seen across the spectrum of diseases affecting the right heart. The complex anatomy of the right ventricle requires special considerations and echocardiographic techniques, which are set out in this document. The clinical relevance of right ventricular diastolic function is introduced, with practical guidance for its assessment. Finally, the relatively novel techniques of three-dimensional right ventricular echocardiography and right ventricular speckle tracking imaging are described. Despite these techniques holding considerable promise, issues relating to reproducibility and inter-vendor variation have limited their clinical utility to date.

Open access

Liam Ring, Benoy N Shah, Sanjeev Bhattacharyya, Allan Harkness, Mark Belham, David Oxborough, Keith Pearce, Bushra S Rana, Daniel X Augustine, Shaun Robinson, and Christophe Tribouilloy

The guideline provides a practical step-by-step guide in order to facilitate high-quality echocardiographic studies of patients with aortic stenosis. In addition, it addresses commonly encountered yet challenging clinical scenarios and covers the use of advanced echocardiographic techniques, including TOE and Dobutamine stress echocardiography in the assessment of aortic stenosis.

Open access

Daniel X Augustine, Lindsay D Coates-Bradshaw, James Willis, Allan Harkness, Liam Ring, Julia Grapsa, Gerry Coghlan, Nikki Kaye, David Oxborough, Shaun Robinson, Julie Sandoval, Bushra S Rana, Anjana Siva, Petros Nihoyannopoulos, Luke S Howard, Kevin Fox, Sanjeev Bhattacharyya, Vishal Sharma, Richard P Steeds, Thomas Mathew, and the British Society of Echocardiography Education Committee

Pulmonary hypertension is defined as a mean arterial pressure of ≥25 mmHg as confirmed on right heart catheterisation. Traditionally, the pulmonary arterial systolic pressure has been estimated on echo by utilising the simplified Bernoulli equation from the peak tricuspid regurgitant velocity and adding this to an estimate of right atrial pressure. Previous studies have demonstrated a correlation between this estimate of pulmonary arterial systolic pressure and that obtained from invasive measurement across a cohort of patients. However, for an individual patient significant overestimation and underestimation can occur and the levels of agreement between the two is poor. Recent guidance has suggested that echocardiographic assessment of pulmonary hypertension should be limited to determining the probability of pulmonary hypertension being present rather than estimating the pulmonary artery pressure. In those patients in whom the presence of pulmonary hypertension requires confirmation, this should be done with right heart catheterisation when indicated. This guideline protocol from the British Society of Echocardiography aims to outline a practical approach to assessing the probability of pulmonary hypertension using echocardiography and should be used in conjunction with the previously published minimum dataset for a standard transthoracic echocardiogram.

Open access

Shaun Robinson, Bushra Rana, David Oxborough, Rick Steeds, Mark Monaghan, Martin Stout, Keith Pearce, Allan Harkness, Liam Ring, Maria Paton, Waheed Akhtar, Radwa Bedair, Sanjeev Bhattacharyya, Katherine Collins, Cheryl Oxley, Julie Sandoval, Rebecca Schofield MBChB, Anjana Siva, Karen Parker, James Willis, and Daniel X Augustine

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 disease. 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’ 2D 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.

Open access

David Oxborough, Daniel Augustine, Sabiha Gati, Keith George, Allan Harkness, Thomas Mathew, Michael Papadakis, Liam Ring, Shaun Robinson, Julie Sandoval, Rizwan Sarwar, Sanjay Sharma, Vishal Sharma, Nabeel Sheikh, John Somauroo, Martin Stout, James Willis, and Abbas Zaidi

Sudden cardiac death (SCD) in an athlete is a rare but tragic event. In view of this, pre-participation cardiac screening is mandatory across many sporting disciplines to identify those athletes at risk. Echocardiography is a primary investigation utilized in the pre-participation setting and in 2013 the British Society of Echocardiography and Cardiac Risk in the Young produced a joint policy document providing guidance on the role of echocardiography in this setting. Recent developments in our understanding of the athlete’s heart and the application of echocardiography have prompted this 2018 update.

Open access

Daniel X Augustine, Lindsay D Coates-Bradshaw, James Willis, Allan Harkness, Liam Ring, Julia Grapsa, Gerry Coghlan, Nikki Kaye, David Oxborough, Shaun Robinson, Julie Sandoval, Bushra S Rana, Anjana Siva, Petros Nihoyannopoulos, Luke S Howard, Kevin Fox, Sanjeev Bhattacharyya, Vishal Sharma, Richard P Steeds, Thomas Mathew, and the British Society of Echocardiography Education Committee

Open access

Rebecca Dobson, Arjun K Ghosh, Bonnie Ky, Tom Marwick, Martin Stout, Allan Harkness, Rick Steeds, Shaun Robinson, David Oxborough, David Adlam, Susannah Stanway, Bushra Rana, Thomas Ingram, Liam Ring, Stuart Rosen, Chris Plummer, Charlotte Manisty, Mark Harbinson, Vishal Sharma, Keith Pearce, Alexander R Lyon, Daniel X Augustine, and the British Society of Echocardiography (BSE) and the British Society of Cardio-Oncology (BCOS)

The subspecialty of cardio-oncology aims to reduce cardiovascular morbidity and mortality in patients with cancer or following cancer treatment. Cancer therapy can lead to a variety of cardiovascular complications, including left ventricular systolic dysfunction, pericardial disease, and valvular heart disease. Echocardiography is a key diagnostic imaging tool in the diagnosis and surveillance for many of these complications. The baseline assessment and subsequent surveillance of patients undergoing treatment with anthracyclines and/or human epidermal growth factor (EGF) receptor (HER) 2-positive targeted treatment (e.g. trastuzumab and pertuzumab) form a significant proportion of cardio-oncology patients undergoing echocardiography. This guideline from the British Society of Echocardiography and British Cardio-Oncology Society outlines a protocol for baseline and surveillance echocardiography of patients undergoing treatment with anthracyclines and/or trastuzumab. The methodology for acquisition of images and the advantages and disadvantages of techniques are discussed. Echocardiographic definitions for considering cancer therapeutics-related cardiac dysfunction are also presented.

Open access

Richard P Steeds, Martin R Cowie, Bushra S Rana, John B Chambers, Simon Ray, Janaki Srinivasan, Konstantin Schwarz, Christopher J Neil, Caroline Scally, John D Horowitz, Michael P Frenneaux, Cristina Pislaru, Dana K Dawson, Oliver J Rothwell, Keith George, John D Somauroo, Rachel Lord, Mike Stembridge, Rob Shave, Martin Hoffman, Euan A Ashley, Francois Haddad, Thijs M H Eijsvogels, David Oxborough, Reinette Hampson, Chris D Kinsey, Sothinathan Gurunathan, Anastasia Vamvakidou, Nikolaos Karogiannis, Roxy Senior, Shahram Ahmadvazir, Benoy N Shah, Konstantinos Zacharias, Dan Bowen, Shaun Robinson, Ugochukwu Ihekwaba, Karen Parker, James Boyd, Cameron G Densem, Charlotte Atkinson, Jonathan Hinton, Edmund B Gaisie, Dhrubo J Rakhit, Arthur M Yue, Paul R Roberts, Dean Thomas, Pat Phen, Jonathan Sibley, Sarah Fergey, and Paul Russhard

Open access

Vishal Sharma, Martin Stout, Keith Pearce, Allan L Klein, Maryam Alsharqi, Petros Nihoyannopoulos, Jamal Nasir Khan, Timothy Griffiths, Kully Sandhu, Sinead Cabezon, Chun Shing Kwok, Shanat Baig, Tamara Naneishvili, Vetton Chee Kay Lee, Arron Pasricha, Emily Robins, Prathap Kanagala, Tamseel Fatima, Andreea Mihai, Robert Butler, Simon Duckett, Grant Heatlie, Haotian Gu, Phil Chowienczyk, Linda Arnold, Sean Coffey, Margaret Loudon, Jo Wilson, Andrew Kennedy, Saul G Myerson, Bernard Prendergast, Alice M Jackson, Vera Lennie, Peter Lee Luke, Christopher James Eggett, Loakim Spyridopoulos, Timothy Simon Irvine, Nashwah Ismail, Anita Macnab, Caroline Bleakley, Mehdi Eskandari, Omar Aldalati, Almira Whittaker, Marilou Huang, Mark J Monaghan, Thomas J Turner, Conor Steele, Anna Barton, Alan C Cameron, Sonecki Piotr, Phang Gyee Vuei, Christos Voukalis, Hwee Phen Teh, Stavros Apostolakis, Chih Wong, Matthew M Y Lee, Nicolas E R Goodfield, Emma Lane, David Slessor, Richard Crawley, Theodoros Ntoskas, Farhanda Ahmad, Paul Woodmansey, Andrew J Fletcher, Shaun Robinson, Bushra S Rana, Liam Batchelor, Brogan McAdam, Caroline J Coats, Louise C Mayall, Niall G Campbell, and Hannah Garnett