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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

This guideline presents reference limits for use in echocardiographic practice, updating previous guidance from the British Society of Echocardiography. The rationale for change is discussed, in addition to how the reference intervals were defined and the current limitations to their use. The importance of interpretation of echocardiographic parameters within the clinical context is explored, as is grading of abnormality. Each of the following echo parameters are discussed and updated in turn: left ventricular linear dimensions and LV mass; left ventricular volumes; left ventricular ejection fraction; left atrial size; right heart parameters; aortic dimensions; and tissue Doppler imaging. There are several important conceptual changes to the assessment of the heart’s structure and function within this guideline. New terminology for left ventricular function and left atrial size are introduced. The British Society of Echocardiography has advocated a new approach to the assessment of the aortic root, the right heart, and clarified the optimal methodology for assessment of LA size. The British Society of Echocardiography has emphasized a preference to use, where feasible, indexed measures over absolute values for any chamber size.

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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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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.

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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 Battacharyya, 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

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