Echocardiography: the transition from master of the craft to admiral of the fleet

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Echocardiography has become essential for the diagnosis and management of cardiovascular disease. Over my medical career, cardiac ultrasound has evolved from the blurry wavy lines of M-mode tracings understandable only to a few dedicated practitioners, to real-time intuitive anatomic images accessible to all healthcare providers. In addition, the development and validation of quantitative imaging and Doppler techniques has transformed clinical cardiology with the ability to measure left ventricular ejection fraction and cardiac output, estimate pulmonary pressures, evaluate diastolic function, and quantitate valve and congenital heart disease severity. More advanced imaging modalities including transoesophageal imaging, real-time three-dimensional (3D) and biplane imaging, contrast echocardiography, tissue Doppler, and other modalities have further extended our diagnostic capabilities. There is no question that echocardiography is an accurate and powerful diagnostic tool when performed and interpreted by highly skilled professionals at centres with a high volume of complex cardiac disease. However, the real challenge is ensuring that echocardiographic diagnosis is accurate and reliable, regardless of where or when the study is performed, resulting in improved patient outcomes. Unfortunately, many experts are concerned that the current quality of echocardiography across the clinical community fails to meet this goal.1

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