The Integration of Doppler Ultrasound With Two-Dimensional Echocardiography and the Noninvasive Cardiac Hemodynamic Revolution of the 1980s
CME Information: 1.00 credits
Release date: Dec 2018 Valid through: Dec 2019
Introduction/Statement of Need:
In the 1970s, as cardiac imaging matured from M-mode to two-dimensional echocardiography, investigators in Norway showed that continuous-wave Doppler ultrasonography could be used to accurately measure the mean gradient and pressure half-time for stenotic mitral valves. In the 1980s, continuous-wave Doppler was validated for measurement of the pressure gradient across stenotic aortic valves, and pulsed-wave Doppler combined with two-dimensional echocardiographic imaging was validated for noninvasive measurement of stroke volume and cardiac output. The combination of stroke volume measurement and measurement of the time-velocity integral of flow through the aortic valve was then validated as a means to accurately calculate valve area for patients with stenotic aortic valves or aortic prostheses. This integration of cardiac Doppler ul- trasonography with two-dimensional echocardiographic cardiac imaging led to a revolution in noninvasive he- modynamic evaluations, which have replaced invasive hemodynamic evaluations in surgical decision making for most patients with native or prosthetic valvular stenosis.
This activity is designed for all cardiac sonographers and cardiovascular physicians with a primary interest and knowledge base in the field of echocardiography; in addition, residents, researchers, clinicians, intensivists, and other medical professionals.
At the end of this article the reader will better be able to:
1. Describe the history and validation of Doppler measurements for noninvasive assessment of cardiac pressures and function
2. Analyze the relative advantages of Doppler echocardiography in assessing native and prosthetic valve function
3. Detail the various views and techniques used in ensuring accurate pressure gradient measurements in native aortic stenosis and prosthetic aortic valves
4. Recognize important advantages of Doppler echocardiography in making surgical decision for patients with aortic stenosis
The American Society of Echocardiography is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The American Society of Echocardiography designates this enduring material for a maximum of 1.00 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC point in the American Board of Internal Medicine's (ABIM). Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.[CL1]
ARDMS, CCI and Sonography Canada recognize ASE’s certificates and have agreed to honor the credit hours toward their registry requirements for sonographers.
The American Society of Echocardiography is committed to ensuring that its educational mission and all sponsored educational programs are not influenced by the special interests of any corporation or individual, and its mandate is to retain only those authors whose financial interests can be effectively resolved to maintain the goals and educational integrity of the activity. While a monetary or professional affiliation with a corporation does not necessarily influence an author’s presentation, the Essential Areas and policies of the ACCME require that any relationships that could possibly conflict with the educational value of the activity be resolved prior to publication and disclosed to the audience. Disclosures of faculty and commercial support relationships, if any, have been indicated.
Fletcher A. Miller, Jr., MD, FASE, Rochester, Minnesota
According to ACCME policy, ASE implemented mechanisms to resolve all conflicts of interest prior to the planning and implementation of this activity.
The following author(s) reported no actual or potential conflicts of interest in relation to this document:
Fletcher A. Miller, Jr., MD, FASE
The following 2017-2018 ASE Board of Directors reviewed this document and reported no actual or potential conflicts of interest in relation to this document:
Reviewers included Jayashri Aragam, MD, FASE; Bonita Anderson, MApplSC, DMU, AMS, ACS, AFASA, FASE; Keith Collins, MS, RDCS, FASE; Gregory Ensing, MD, FASE; Alan Finley, MD, FASE; Edward Gill, MD, FASE; Amer Johri, MD, FASE; James Kirkpatrick, MD, FASE; Wyman Lai, MD, MPH, FASE; Jonathan Lindner, MD, FASE; G. Burkhard Mackensen, MD, PhD, FASE; Michael Main, MD, FASE; Elizabeth McIlwain, MPH, RCS, FASE; Carol Mitchell, PhD, RDMS, RDCS, RVT, RT(r), FASE; Geoffrey Rose, MD, FASE; Liza Sanchez, RCS, FASE; Elaine Shea, ACS, RCS, RCCS, FASE; Madhav Swaminathan, MD, FASE;
The following board and guidelines and standards committee members reported relationships with one or more commercial interests:
The following ACCME reviewers, ASE Staff and CME editors reported no actual or potential conflicts of interest in relation to this document:
Jennifer Betz, BS, RDCS, FASE, Shubhika Srivastava MD, FASE, Patricia Foster and Christina LaFuria
The following ACCME reviewers, ASE Staff and CME editors reported relationships with one or more commercial interests:
Method of Participation: Online Only
Estimated Time to Complete this Activity: 1 hour
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To receive online CME credit for this activity, read the full activity then complete the posttest and evaluation. A score of 70% or higher is required for successful completion. You will be able to print your CME certificate immediately following successful completion of the posttest and evaluation.
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