Skip to main content
Download PDF

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)Cite this article

Abstract

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.

References

  1. 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)

    Article  Google Scholar 

  2. 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)

    Article  Google Scholar 

  3. 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)

    Article  Google Scholar 

  4. 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.

    PubMed  Google Scholar 

  5. 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)

    Article  Google Scholar 

  6. Intensive Care Society. Focused intensive care echo. (available at: http://www.ics.ac.uk/ICS/fice.aspx). Accessed on 28th January 2020.

  7. 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.

  8. 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)

    Article  Google Scholar 

  9. 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.

    Google Scholar 

  10. 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)

    PubMed  PubMed Central  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. 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)

    Article  CAS  Google Scholar 

  13. Zagzebski JA Essentials of Ultrasound Physics. St Louis, Missouri: Mosby, Inc., 1996.

    Google Scholar 

  14. Denault AY, Couture P, Vegas A, Buithieu J, Tardif JC Transoesophageal Echocardiography: Multimedia Manual–A Perioperative Transdisciplinary Approach, 2nd ed. London: Informa Healthcare, 2011.

    Google Scholar 

  15. 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)

    Article  Google Scholar 

  16. 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)

    Article  Google Scholar 

  17. Feigenbaum H, Armstrong WF, Ryan T Feigenbaum’s Echocardiography, 6th ed. Philadelphia: Lipincott Williams and Wilkins, 2005.

    Google Scholar 

  18. 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)

    PubMed  Google Scholar 

  19. 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)

    PubMed  Google Scholar 

  20. 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)

    CAS  PubMed  Google Scholar 

  21. 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)

    Google Scholar 

  22. 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)

    Article  Google Scholar 

  23. 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)

    CAS  PubMed  PubMed Central  Google Scholar 

  24. 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)

    Article  Google Scholar 

  25. 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)

    Article  Google Scholar 

  26. 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)

    Article  Google Scholar 

  27. 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.

    Google Scholar 

  28. 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)

    PubMed  Google Scholar 

  29. 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.

  30. 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)

    PubMed  PubMed Central  Google Scholar 

  31. 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)

    Article  Google Scholar 

  32. 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)

    Article  Google Scholar 

  33. 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.

    Google Scholar 

  34. 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)

    Article  Google Scholar 

  35. 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)

    Article  Google Scholar 

  36. Otto C The Practice of Clinical Echocardiography, 4th ed. Philadelphia: Elsevier Saunders, 2012.

    Google Scholar 

  37. 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)

    Article  Google Scholar 

  38. 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)

    CAS  PubMed  Google Scholar 

  39. 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)

    PubMed  Google Scholar 

  40. 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.

    Article  Google Scholar 

  41. 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)

    Article  Google Scholar 

Download references

Acknowledgments

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.

Funding

This work did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Author information

Authors and Affiliations

  1. North West Anglia NHS Foundation Trust, Peterborough, Cambridgeshire, UK

    Shaun Robinson MSc & Rebecca Schofield MBChB

  2. Imperial College Healthcare NHS Trust, London, UK

    Bushra Rana MBBS

  3. Liverpool John Moores University, Research Institute for Sports and Exercise Science, Liverpool, Merseyside, UK

    David Oxborough PhD

  4. University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, West Midlands, UK

    Rick Steeds MBBS

  5. Kings College NHS Foundation Trust, London, UK

    Mark Monaghan PhD

  6. University Hospital South Manchester NHS Foundation Trust, Manchester, UK

    Martin Stout PhD & Keith Pearce

  7. East Suffolk and North Essex NHS Foundation Trust, Essex, UK

    Allan Harkness MSc

  8. West Suffolk Hospital NHS Foundation Trust, Bury St Edmunds, Suffolk, UK

    Liam Ring MBBS

  9. University of Leeds, Leeds, UK

    Maria Paton MSc

  10. Lincolnshire Heart Centre, United Lincoln Hospitals NHS Trust, Lincoln, Lincolnshire, UK

    Waheed Akhtar MSc

  11. University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK

    Radwa Bedair MD

  12. St Bartholomew’s Hospital, London, UK

    Sanjeev Bhattacharyya MD

  13. InHealth Group, Buckinghamshire, UK

    Katherine Collins MSc

  14. University Hospitals of the North Midlands, Stoke-on-Trent, Staffordshire, UK

    Cheryl Oxley BSc

  15. Leeds Teaching Hospitals, Leeds, UK

    Julie Sandoval MA

  16. Portsmouth, UK

    Anjana Siva PhD

  17. East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK

    Karen Parker

  18. Royal United Hospitals Bath NHS Foundation Trust, Bath, UK

    James Willis PhD & Augustine Daniel X MD

Authors
  1. Shaun Robinson MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bushra Rana MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Oxborough PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rick Steeds MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mark Monaghan PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Martin Stout PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Keith Pearce
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Allan Harkness MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Liam Ring MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Maria Paton MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Waheed Akhtar MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Radwa Bedair MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Sanjeev Bhattacharyya MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Katherine Collins MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Cheryl Oxley BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Julie Sandoval MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Rebecca Schofield MBChB
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Anjana Siva PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Karen Parker
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. James Willis PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Augustine Daniel X MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shaun Robinson MSc.

Rights and permissions

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.(http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1530/ERP-20-0026

Key Words

Echo Research & Practice

ISSN: 2055-0464