Indications for Two-Dimensional Echocardiography
Two-dimensional echocardiography (2D echo) is indicated as the first-line imaging modality for real-time evaluation of cardiac structure, function, and hemodynamics in virtually all suspected cardiac conditions. 1
Primary Clinical Indications
Assessment of Cardiac Chamber Size and Function
- Evaluate left ventricular size, systolic function (including ejection fraction), and diastolic function through measurements of chamber dimensions, wall motion, and Doppler parameters 2
- Assess right ventricular size and function including RV fractional area change and tricuspid annular plane systolic excursion 2
- Quantify left ventricular volumes and ejection fraction using the biplane method of disks summation (modified Simpson's rule) from apical four- and two-chamber views 3
- Detect regional wall motion abnormalities in patients with suspected or known coronary artery disease 4
Valvular Heart Disease Evaluation
- Assess mitral valve structure and function including evaluation for stenosis, regurgitation, and prolapse using 2D imaging and color Doppler 2
- Evaluate aortic valve morphology and function including assessment for stenosis and regurgitation with continuous wave Doppler 2
- Examine tricuspid and pulmonic valves for structural abnormalities and regurgitation 2
Detection of Structural Abnormalities
- Identify congenital heart defects including atrial septal defects, ventricular septal defects, and other anatomic anomalies 1, 4
- Detect intracardiac masses such as thrombi, tumors, and vegetations 3
- Evaluate pericardial disease including presence of pericardial effusion and signs of tamponade 2
Hemodynamic Assessment
- Estimate pulmonary artery pressures using tricuspid regurgitation velocity and pulmonary valve acceleration time 2
- Calculate stroke volume and cardiac output using left ventricular outflow tract velocity time integral 5
- Assess diastolic function through mitral inflow patterns (E/A ratio, deceleration time) and tissue Doppler e' velocity 2, 5
Advanced Applications
Strain Imaging
- Measure global longitudinal strain using speckle tracking technology to detect subclinical left ventricular dysfunction, particularly in patients receiving cardiotoxic therapy 2, 6
Monitoring and Follow-up
- Serial assessment in patients with change in clinical status or symptoms to monitor disease progression 2
- Regular monitoring after therapy with cardiotoxic agents to detect early ventricular dysfunction 2
- Follow-up of known moderate or greater pulmonary hypertension to assess treatment response 2
Technical Advantages Supporting These Indications
2D echocardiography offers several critical advantages that make it the preferred initial imaging modality 1:
- Widely available and reproducible with no radiation exposure
- Provides real-time dynamic evaluation of cardiac structures throughout the cardiac cycle
- Safe and painless requiring no sedation in most patients
- Allows simultaneous assessment of structure, function, and hemodynamics
Common Pitfalls to Avoid
- Foreshortening of the left ventricle leads to volume underestimation; maximize LV areas in apical views to avoid this error 3
- Poor endocardial border definition in two or more contiguous segments warrants use of contrast agents to improve accuracy 3
- Suboptimal acoustic windows may require alternative imaging windows or consideration of contrast enhancement 1
- Geometric assumptions inherent in 2D measurements can be inaccurate in asymmetric ventricles; consider 3D echocardiography when available for more accurate volumetric assessment 3, 7