Echocardiography Is Increasingly Important in Evaluating Cardiac Function, Especially in Women
Nov 4, 1999
Benjamin H. Lewis, MD, of the Columbia Presbyterian Center of New York-Presbyterian Hospital, has become the first cardiologist in New York State to receive accreditation from the Intersocietal Commission of Accreditation of Echocardiography Laboratories (ICAEL) for stress echocardiography, a noninvasive method of diagnosing cardiac disease.
Reflecting Columbia Presbyterian's leadership in cardiac care and diagnosis, Dr. Lewis' accreditation places him among an elite membership to have been granted such status in the United States, Canada, and Puerto Rico. While echocardiography is increasingly seen as an invaluable addition to the cardiac diagnostic armamentarium because of its accuracy, its results are dependent on the technical skill of the sonographer performing the test and on the expertise of the physician interpreting it. The test has become one of the standard diagnostic cardiac tools, with approximately 10 million performed each year in the United States.
Echocardiography yields very clear pictures of both healthy and diseased cardiac muscle by bouncing inaudible, high-frequency sound waves off the heart tissue. Cardiac structure and flow information provided by this technique can be invaluable in diagnosing heart disease. In addition to being painless and noninvasive, the procedure produces immediate results, in contrast to nuclear imaging technologies, whose results must be developed and analyzed.
According to Dr. Lewis, who is an Assistant Attending Physician at the Columbia Presbyterian Center of New York Presbyterian Hospital and Assistant Professor of Clinical Medicine at Columbia University's College of Physicians and Surgeons, studies have demonstrated that echocardiography rivals nuclear-based methods in eliciting vital information about cardiac function.
"Just as important as the quick and easy, high-quality information we can obtain from echocardiography is the fact that this technique has been found to be particularly useful in diagnosing cardiac disease in women. In the past, women were traditionally regarded, both by many physicians and by women themselves, as unlikely to have heart attacks. Others who recognized that women were vulnerable to heart attacks thought that they could be diagnosed and treated the same way as men. As a result, women have been underdiagnosed, or diagnosed only after they have already had a heart attack, or undertreated. Fortunately, we are increasingly aware that there are differences in both the diagnosis and the manifestation of cardiac disease in the sexes, and now we are able to do something about it," notes Dr. Lewis. He adds that the use of echocardiography is particularly important as a diagnostic tool for women suspected of having cardiac disease and represents an important step in bringing state-of-the-art cardiac care to women.
Traditionally, the treadmill EKG stress test has been used as the gold standard for diagnosing heart disease in both men and women. However, while this test effectively diagnoses cardiac malfunction in most men, it may produce false positive readings in women up to 30 percent of the time. Studies have shown that echocardiography is an extremely effective and accurate method of diagnosing women and men with heart disease. Unlike nuclear based diagnostic tests, echocardiography involves no exposure to radiation. Furthermore, in nuclear-based diagnostic techniques, a true picture of cardiac function is not always achieved because of the shadows produced by breast tissue, and intravenous injections are required.
"The tremendous diagnostic advantages of echocardiography are being recognized. It's time-effective, cost-effective, and noninvasive, and it gives us an immediate, comprehensive view of cardiac function. It's an invaluable test for women. Its use may greatly help to close the gender gap in diagnosing cardiac disease," concludes Dr. Lewis.
The ICAEL was established with the support of the American Society of Echocardiography, the American College of Cardiology, and the Society of Pediatric Echocardiography to provide a peer-review mechanism to encourage and recognize the provision of quality echocardiographic diagnostic evaluations by a process of voluntary accreditation.