Crown years for noninvasive cardiovascular imaging (part I): 60 years of echocardiography

[摘要] The development of diagnostic ultrasound in cardiology started in Lund, Sweden in 1953, originating from the successful cooperation between the physician Inge Edler (1911–2001) and the physicist Hellmuth Hertz (1920–1990). The first echocardiographic recording in man was performed on Thursday 29 October 1953 and published in 1954 [1]. Equipped with the ‘Ultraschall Impulsgerät’ (the Siemens Ultrasound Reflectoscope), Inge Edler and Hellmuth Hertz recorded the first moving pictures of the heart, thereby inaugurating the field of ‘ultrasound cardiography’, at that time called UCG. The first echoes, recorded via M (motion) mode, were obtained from the posterior wall of the left ventricle and from another structure thought to be the anterior wall of the left atrium. The invention of ultrasound echocardiography marked the beginning of a completely new diagnostic noninvasive technique in cardiovascular medicine. Edler used this technique primarily for the preoperative study of mitral valve stenosis and diagnosis of mitral regurgitation. The Swedish efforts were further conveyed by European and American research groups. Harvey Feigenbaum (Indianapolis, USA) sought answers in ultrasound because he was ‘frustrated with the tediousness and inaccuracies of using the catheterisation techniques to measure the cardiac output, volumes and pressures’. In the late 1960s, Feigenbaum, who in fact coined the name echocardiography, showed that left ventricular wall thickness, internal dimensions, stroke volume, ejection fraction, and valvular regurgitation could all be measured by echocardiography [2]. In the Netherlands, the group headed by Professor Nicolaas Bom (Rotterdam, and ICIN, Utrecht) had already made major breakthroughs with the development of a multi-element linear array transducer making real-time imaging possible in 1971 [3]. From that moment on, the first successful two-dimensional echocardiograms were performed allowing the visualisation of wall motion abnormities in patients with coronary artery disease [4, 5]. In 1973, Johnson and Dodge [6] combined two-dimensional echocardiography with pulsed Doppler imaging to enable the detection of flow signals from specific locations within the heart or great vessels; duplex scanning was born. Simultaneously, another major breakthrough in Doppler came in 1976, when Holen [7] and later on Liv Hatle (Trondheim, Sweden) noted that a modified Bernoulli equation could be used to detect pressure gradients across stenotic valves and demonstrated that haemodynamic data could be accurately determined with Doppler ultrasound [8]. In an effort to attain a better visualisation ‘window,’ Frazin and colleagues [9], in 1976, accomplished transoesophageal echocardiography. Further pioneering research in echocardiography in the Netherlands was performed by (among others) the professors Jos Roelandt (Rotterdam), Cees Visser (Amsterdam, and ICIN, Utrecht), Ton der Steen and Nico de Jong (Rotterdam, and ICIN, Utrecht), and Jeroen Bax (Leiden) [10–14]. Important technical advancements in the ultrasonic field, such as intravascular ultrasound, three-dimensional echocardiography, contrast echocardiography, intracardiac echocardiography, dobutamine-stress echocardiography, speckle tracking and handheld echocardiography (‘the virtual stethoscope’) have made echocardiography the most widely used noninvasive cardiovascular imaging technique in the world [15, 16]. For a wide variety of cardiovascular diseases, echocardiography has become the noninvasive imaging technique of choice [17–20].

[学科分类] 心脏病和心血管学