A practical guideline for performing a comprehensive transthoracic echocardiogram in adults: the British Society of Echocardiography minimum dataset
Echo Research & Practice volume 7, pages G59–G93 (2020)
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.
Dave JK, McDonald ME, Mehrotra P, Kohut AR, Eisenbrey JR, Forsberg F Recent technological advances in cardiac ultrasound imaging. Ultrasonics 2018 84 329–340. (https://doi.org/10.1016/j.ultras.2017.11.013)
Weigers SE, Ryan T, Arrighi JA, Brown SM, Canaday B, Damp JB, Diaz-Gomez JL, Figueredo VM, Garcia MJ, Gillam LD et al. ACC/AHA/ASE advanced training statement on echocardiography (revision of the 2003 ACC/AHA Clinic Competence Statement on Echocardiography). Journal of the American College of Cardiology 2019 74 377–402. (https://doi.org/10.1016/j.jacc.2019.02.003)
Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, Horton K, Ognyankin KO, Palma RA, Velazquez EJ Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography. Journal of the American Society of Echocardiography 2019 32 1–64. (https://doi.org/10.1016/j.echo.2018.06.004)
Galderisi M, Cosyns B, Edvardsen T, Cardim N, Delgado V, Di Salvo G, Donal E, Elif Sade L, Ernande L, Garbi M et al. Standardization of adult transthoracic echocardiography reporting agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: expert consensus document of the European Association of Cardiovascular Imaging. European Heart Journal: Cardiovascular Imaging 2017 18 1301–1310.
Price S, Uddin S, Quinn T Echocardiography in cardiac arrest. Current Opinion in Critical Care 2010 16 211–215. (https://doi.org/10.1097/MCC.0b013e3283399d4c)
Intensive Care Society. Focused intensive care echo. (available at: http://www.ics.ac.uk/ICS/fice.aspx). Accessed on 28th January 2020.
British Society of Echocardiography. Level 1 accreditation. (available at: https://www.bsecho.org/Public/Accreditation/Personal-accreditation/Level-1/Public/Accreditation/Accreditation-subpages/Personal-accreditation-subpages/Level-1-accreditation.aspx?hkey=6099b4b8-5cb9-4425-a201-1874aadcb73f). Accessed on 28th January 2020.
Pallotta OJ, Roberts A Musculoskeletal Pain and Injury in sonographers, causes and solutions. Sonography 2017 4 5–12. (https://doi.org/10.1002/sono.12093)
British Society of Echocardiography. Departmental accreditation. (available at: https://www.bsecho.org/Public/Accreditation/Departmental-accreditation/Public/Accreditation/Accreditation-subpages/Departmental-accreditation.aspx?hkey=a61c9cf9-c639-49cd-abcd-cee2185f1246). Accessed on 28th January 2020.
Kou S, Caballero L, Dulgheru R, Voilliot D, De Sousa C, Kacharava G, Athanassopoulos GD, Barone D, Baroni M, Cardim et al. Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study. European Heart Journal: Cardiovascular Imaging 2014 15 680–690. (https://doi.org/10.1093/ehjci/jet284)
Harkness A, Ring L, Augustine D, Oxborough D, Robinson S, Sharma V, Stout M Normal reference intervals for cardiac dimensions and function for use in echocardiographic practice: a guideline from the British Society of Echocardiography. Echo Research and Practice 2020 7 G1–G18.
Ricci DR, Orlick AE, Alderman EL, Ingels NB, Daughters GT, Stinson EB Influence of heart rate on left ventricular ejection fraction in human beings. American Journal of Cardiology 1979 44 447–451. (https://doi.org/10.1016/0002-9149(7990395-3)
Zagzebski JA Essentials of Ultrasound Physics. St Louis, Missouri: Mosby, Inc., 1996.
Denault AY, Couture P, Vegas A, Buithieu J, Tardif JC Transoesophageal Echocardiography: Multimedia Manual–A Perioperative Transdisciplinary Approach, 2nd ed. London: Informa Healthcare, 2011.
Perperidis A, McDicken N, McGillivray T, Anderson T Elevational spatial compounding for enhancing image quality in echocardiography. Ultrasound 2016 24 74–85. (https://doi.org/10.1177/1742271X16632283)
Uppal T Tissue harmonic imaging. Australasian Journal of Ultrasound in Medicine 2010 13 29–31. (https://doi.org/10.1002/j.2205-0140.2010.tb00155.x)
Feigenbaum H, Armstrong WF, Ryan T Feigenbaum’s Echocardiography, 6th ed. Philadelphia: Lipincott Williams and Wilkins, 2005.
Mada RO, Lysyansky P, Daraban AM, Duchenne J, Voigt JU How to define end-diastole and end-systole? Impact of timing on strain measurements. JACC: Cardiovascular Imaging 2015 8 148–157. (https://doi.org/10.1016/j.jcmg.2014.10.010)
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal: Cardiovascular Imaging 2015 16 233–270. (https://doi.org/10.1093/ehjci/jev014)
Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, Pedri S, Ito Y, Abe Y, Metz S et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. European Heart Journal: Cardiovascular Imaging 2015 16 1–11. (https://doi.org/10.1093/ehjci/jeu184)
Lyon AR, Dent S, Stanway S, Earl H, Brezden-Masley C, Cohen-Solal A, Tocchetti CG, Moslehi JJ, Groarke JD, Bergler-Klein J et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European society of Cardiology in collaboration with the International Cardio-Oncology Society. European Journal of Heart Failure/Early View 2020 21 1945–1960. (https://doi.org/10.1002/ejhf.1920)
Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, Ganame J, Sebag IA, Agler DA, Badano LP et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal Cardiovascular Imaging 2014 15 1063–1093. (https://doi.org/10.1093/ehjci/jeu192)
Kotecha D, Piccini JP Atrial fibrillation in heart failure: what should we do? European Heart Journal 2015 36 3250–3257. (https://doi.org/10.1093/eurheartj/ehv513)
Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Munoz D et al. 2017 SC/EACTS Guidelines for the management of valvular heart disease: the Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS at). European Heart Journal 2017 38 2739–2791. (https://doi.org/10.1093/eurheartj/ehx391)
Wharton G, Steed R, Allen J, Phillips H, Jones R, Kanagala P, Lloyd G, Masani N, Mathew T, Oxborough D et al. A minimum dataset for a standard adult transthoracic echocardiogram: a guideline protocol from the British Society of Echocardiography. Echo Research and Practice 2015 2 G9–G24. (https://doi.org/10.1530/ERP-14-0079)
Kotecha D, Mohamed M, Shantsila E, Popescu BA, Steeds RP Is echocardiography valid and reproducible in patients with atrial fibrillation? A systematic review. Europace 2017 19 1427–1438. (https://doi.org/10.1093/europace/eux027)
Mathew T, Steeds R, Jones R, Kanagala P, Lloyd G, Knight D, O’Gallagher K, Oxborough D, Rana B, Ring L et al. A guideline protocol for the echocardiographic assessment of diastolic dysfunction. (available at: https://www.bsecho.org/common/Uploaded%20files/Education/Protocols%20and%20guidelines/Diastolic%20dysfunction.pdf). Accessed on 01 September 2020.
Galderisi M, Cosyns B, Edvardsen T, Cardim N, Delgado V, Di Salvo G, Donal E, Elif Sade LE, Ernande L, Garbi M et al. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. European Heart Journal: Cardiovascular Imaging 2017 18 1301–1310. (https://doi.org/10.1093/ehjci/jex244)
British Society of Echocardiography chaperone policy. (available at: https://www.bsecho.org/common/Uploaded%20files/Education/Protocols%20and%20guidelines/Chaperones%20and%20echocardiography.pdf). Accessed on 23rd June 2020.
Marwick TH Techniques for comprehensive two dimensional echocardiographic assessment of left ventricular systolic function. Heart 2003 89 (Supplement 3) iii2–iii8. (https://doi.org/10.1136/heart.89.suppl_3.iii2)
Marwick TH Ejection fraction pros and cons: JACC state-of-the-art review. Journal of the American College of Cardiology 2018 72 2360–2379. (https://doi.org/10.1016/j.jacc.2018.08.2162)
Zaidi A, Knight DS, Augustine DX, Harkness A, Oxborough D, Pearce K, Ring L, Robinson S, Stout M, Willis J et al. Echocardiographic assessment of the right heart in adults: a guideline protocol from the British Society of Echocardiography. Echo Research and Practice 2020 7 G19–G41. (https://doi.org/10.1530/ERP-19-0051)
Rana B, Robinson S Transthoracic anatomy and pathology: valves’in Leeson. In Oxford Specialist Handbooks in Cardiology: Echcardiography, 3rd ed. Eds Monteiro P, Augustin C, Becher D Oxford University Press, 2020.
Baumgartner H, Hung J, Bermejo J, Chambers JB, Edvardsen T, Goldstein S, Lancellotti P, LeFevre M, Miller F, Otto CM Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Journal of the American Society of Echocardiography 2017 30 372–392. (https://doi.org/10.1016/j.echo.2017.02.009)
Augustine DX, Coates-Bradshaw LD, Willis J, Harkness A, Ring L, Grapsa J, Coghlan G, Kaye N, Oxborough D, Robinson S et al. Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography. Echo Research and Practice 2018 5 G11–G24. (https://doi.org/10.1530/ERP-17-0071)
Otto C The Practice of Clinical Echocardiography, 4th ed. Philadelphia: Elsevier Saunders, 2012.
Steed RP, Wheeler R, Bhattacharyya S, Reiken J, Nihoyannopoulos P, Senior R, Monaghan MJ, Sharma V Stress echocardiography in coronary artery disease: a practical guideline Rom the British Society of Echocardiography. Echo Research and Practice 2019 6 G17–G33. (https://doi.org/10.1530/ERP-18-0068)
Voigt J-U, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, Pedri S, Ito Y, Abe Y, Metz S et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardise deformation imaging. European Heart Journal: Cardiovascular Imaging 2015 16 1–11. (https://doi.org/10.1093/ehjci/jeu184)
Huang X, Huang Y, Huang T, Huang W, Huang Z Individual pulmonary vein imaging by transthoracic echocardiography: an inadequate traditional interpretation. European Journal of Echocardiography 2008 9 655–660. (https://doi.org/10.1093/ejechocard/jen032)
Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. Journal of the American Society of Echocardiography 2010 23 685–713; quiz 86–88.
Tamborini G, Muratori M, Brusoni D, Celeste F, Maffessanti F, Caiani EG, Alamanni F, Pepi M Is right ventricular systolic function reduced after cardiac surgery? A two- and three-dimensional echocardiographic study. European Journal of Echocardiography 2009 10 630–634. (https://doi.org/10.1093/ejechocard/jep015)
Andrew Martin BSc, Laura Money BSc and Kerry Ladds BSc (North West Anglia NHS Foundation Trust) are recognised for their contributions in the development of this guideline and for providing images used within.
This work did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
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Robinson, S., Rana, B., Oxborough, D. et al. A practical guideline for performing a comprehensive transthoracic echocardiogram in adults: the British Society of Echocardiography minimum dataset. Echo Res Pract 7, G59–G93 (2020). https://doi.org/10.1530/ERP-20-0026