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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EProf Gerald Maurer presented the Edler Lecture at EuroEcho-Imaging 2014. He provided an overview of the changing imaging landscape over the past 4 decades, noting the benefits and disadvantages to using these sensitive technologies. Clinicians in Europe will soon have evidence-based guidelines to appropriately use imaging in clinical practice.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eheart abnormality\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eechocardiography\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Etomography\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EVal-Heft\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESOLVD\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EThe Edler lecture is presented annually at the EuroEcho-Imaging meeting in honor of Inge Edler, MD, an internationally renowned pioneer in using ultrasound for the medical diagnosis of heart abnormalities. This year\u2019s Edler lecture was presented by Gerald Maurer, MD, Medical University of Vienna, Vienna, Austria. Prof Maurer spoke about the evolution of cardiac imaging techniques over the past 40 years and the impact of these techniques on both patients with heart abnormalities and healthy populations.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EBefore the advent of echocardiography, images of the heart were vague and indistinct. In the 1980s, innovations in cardiac imaging allowed clinicians to see all 4 chambers of the heart, measure ventricular contractions, and see structures even more granularly, such as infections of the mitral valve. Prof Maurer highlighted the impact of newer imaging techniques on a variety of conditions and assessments, including valvular heart disease, left and right ventricular function, myocardial perfusion, myocardial metabolism, and interventional imaging. According to Prof Maurer, intra- and perioperative echocardiograms have revolutionized mitral valve surgery, eventually allowing surgeons to perform many more mitral valve repairs and replacements; as the technology became more sophisticated in the early 1990s, replacement of the mitral valve began to eclipse mitral valve repair.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EProf Maurer emphasized that imaging has a direct impact on patient care as well as on healthy populations. Imaging can provide detailed morphologic, functional, hemodynamic, and molecular data, which can certainly inform patient outcomes. Such data can improve our understanding of cardiac disease processes and risk stratification, allowing researchers to develop new treatment algorithms designed to improve outcomes. In addition, data generated from the technology can also be used to develop screening programs for healthy populations, such as young athletes.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ELike many new technologies, however, there are concerns about overuse and misinterpretation of the data generated from the technology. According to Prof Maurer, sensitive technologies can detect subclinical disease that should be left alone. There is a danger of overinterpretation and of detecting nontarget findings that have no clinical relevance but require additional testing. For example, a computed tomography scan of the abdominal aorta might reveal an adenoma in the adrenal gland or cysts in the kidney. This creates a great deal of anxiety for the patient and additional testing for abnormalities that are not likely to influence long-term outcomes. Advanced cardiac imaging techniques also expose patients to contrast agents or a risk of radiation exposure, and increase the overall cost of healthcare.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EProf Maurer cited an example of an unintended harm to patients related to the overzealous interpretation of echocardiographic testing for mitral valve prolapse (MVP). He estimates that in 1982, the prevalence of MVP in the United States was 14.2%, compared with 2.4% in 2014. This 7-fold decrease is probably not the result of any interventional therapy to eliminate MVP between 1982 and 2014 but more the result of an increasing use of noninvasive, 2D echocardiography in the early 1980s. Clinicians were excited to have this new tool but were likely overzealous in analyzing the imaging results, interpreting even a minimal dip of the mitral leaflet past the mitral annulus as MVP. Many of these early patients had subsequent difficulty purchasing health insurance or were unable to attain employment because they were considered \u201chigh risk.\u201d\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EImaging plays an important role in providing prognostic information. Information from the Val-Heft trial showed that measurements of the left ventricular (LV) internal diameter and ejection fraction obtained via echocardiography could predict mortality among patients with heart failure [Wong M et al. \u003Cem\u003EJ Am Coll Cardiol.\u003C\/em\u003E 2004]. Similar data were obtained regarding the relationship of LV and left atrial dimensions, ejection fraction, and LV mass to subsequent clinical outcome of patients with heart failure enrolled in the SOLVD Registry and trials [Quinones M et al. \u003Cem\u003EJ Am Coll Cardiol.\u003C\/em\u003E 2000]. According to Prof Maurer, echocardiography has become the tool of choice for patients with valvular heart disease, harking back to early trials suggesting that in adults with asymptomatic aortic stenosis, the rate of hemodynamic progression and clinical outcome were predicted by measurements of velocity across the aortic valve and the rate of velocity change. In a US retrospective cohort study, echocardiography successfully enhanced the predictability of a first cardiovascular event among elderly men and women [Tsang TS et al. \u003Cem\u003EJ Am Coll Cardiol.\u003C\/em\u003E 2004].\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EProf Maurer then went on to discuss the role of imaging in defining the risk of ischemic events. While there is a compelling need for clinicians to identify patients who are at very high risk of developing acute coronary events, there is little evidence as to which imaging techniques might best accomplish that goal. To provide that evidence, some have called for the design of randomized clinical trials that use clinical events as the primary outcome. Ideally, these trials would also test a strategy of imaging compared with no imaging, compare distinct imaging modalities, and focus on hard cardiac end points such as cardiac death or myocardial infarction. However, such trials are difficult to manage, expensive, and often inconclusive. While there are data available from some clinical trials that have investigated imaging as a predictor of ischemic heart disease, it has been difficult to determine whether patients undergoing imaging receive much clinical benefit compared with medical therapy [Boden WE et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2007; Hochman JS et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2006; Mahmarian JJ et al. \u003Cem\u003EJ Am Coll Cardiol.\u003C\/em\u003E 2006].\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003ETo provide clinicians with guidance regarding the use of cardiac imaging in clinical practice, the European Society of Cardiology\/European Association of Cardiovascular Imaging has commissioned a committee to develop a position paper regarding the appropriate criteria for imaging use in clinical practice; the committee has already published a paper describing the process that it is using to develop the criteria [Garbi M et al. \u003Cem\u003EEur Heart J Cardiovasc Imaging.\u003C\/em\u003E 2014]. The appropriateness criteria will be patient centered and encourage clinicians to balance a patient\u2019s need for imaging alongside the need to preserve resources and develop standardized processes care across Europe.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/54\/6.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzob21\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}