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Echocardiogram and cardiac imaging unit

ecocardiograma Vall d'Hebron

The Echocardiography and Cardiac Imaging Unit in the Cardiology Department is responsible for doing the tests needed to diagnose the various heart diseases. These tests are done on heart patients, patients in other specialities and people in hospital. The unit also provides the service for primary care. 
It is a transversal unit and works with other services at the hospital, such as Radiology. Over the past few years, with this joint work, the Echocardiography and Cardiac Imaging Unit has developed and consolidated several specialist sub-units. Some of them are benchmarks at the Spanish and European level.

Description

The Echocardiography and Cardiac Imaging Unit looks after and manages the needs of a great number of people. It has the most advanced technology and heads up knowledge about the speciality. It is a multi-disciplinary unit and brings together caring for people, research and training in day-to-day activities. It has extensive experience in achieving clinical and research breakthroughs. The unit has achieved and published many research milestones.

The unit's services portfolio includes the following: 

Echocardiography laboratory
Each year, this services carries out:

  • 23,000 transthoracic echocardiograms. These include bi-dimensional and advanced 3D and 4D echocardiograms, using Strain to analyse myocardial deformation. 
  • 1,000 transoesophagal echocardiograms with bi-dimensional and advanced 3D and 4D imaging and 3D-CAT fusion. 
  • 150 stress echocardiograms, including exercise and pharmaceutical stress. The unit is certified by the Spanish Cardiology Society, under the SCS Excellence programme, and by the European Cardiology Society.

Transoesophagal echocardiogram guiding for heart valve surgery or structural procedures
Over the past few years, this technique has been included into new procedures to guide the cardiac surgery team. For example, it is used in the aortic valve percutaneous implant, percutaneous repair to the mitral valve, closing the left atrium and closing intracardiac shunts. 

Basal and stress cardiac MRI, cardiac and coronary CAT scans and cardiac and large vessel CT angiography
The unit carries out studies on the diagnostics using images of the myocardial, coronary, pericardial and aorta disease. These are done in collaboration with the Radiology Department. The unit is certified by the European Cardiology Society.

 

Evolution of the department

The Echocardiography and Cardiac Imaging Unit was formed in 1975, within the Cardiology Department. It was responsible for phonocardiograms - a graphic record of cardiac sounds obtained from a stethoscope - and echocardiograms - an ultrasound of the heart. With the passage of time, and technological advances, the unit has brought in other techniques in the field of cardiac imaging, such as: 

  • transoesophagal echocardiogram, from inside the oesophagus
  • 3D and 4D echocardiograms 
  • strain studies on myocardial deformation
  • computerised axial tomography (CAT)
  • cardiac MRI 

These advances mean that the unit’s team are specialists in each one of the technologies. 

The team works together with the Arrhythmia Unit, the Congenital Heart Disease Unit and the Genetics, Cardiac Surgery, Vascular surgery and Paediatric Cardiology departments. Daily collaboration enables advances in the field of heart disease from the clinical and scientific research points of view.
The unit also has the following specialist sub-units: 

  • The Familial Heart Disease Unit has been recognised as a Centre of Excellence in the National Health System, due to its growth in care and research. 
  • The Valve Disease Unit works with the Haemodynamic Unit to offer quality care to patients with aortic and mitral heart valve disease. 
  • The Complex Aortic Disease and Genetic Aortic Disease Unit has become a benchmark in the field, both in Spain and Europe. It is a part of the European Reference Network on Rare Multisystemic Vascular Diseases. 

 

Main diseases related to this speciality

Familial heart diseases
A significant proportion of the people seen in the unit suffer from some kind of familial cardiomyopathy. This is a disease caused by a defect that is genetic in origin, that causes abnormal development of the heart. In some cases it causes exaggerated thickening of the walls and, in others, dilation of the cavities. In both cases abnormal functioning of the heart occurs. Advice from other specialists in genetics and arrhythmia is essential to treat this disease. Collaboration with paediatric cardiology experts is also needed. Treatments include medicines and inserting intracardiac devices that enable the heart to work better and even, in serious cases, prevent sudden death. 

Complex and genetic aortic disease
This is an alteration to the wall of the aorta, which is the body’s main artery. It may increase in size or become more fragile. These changes may cause the artery to rupture or fissure and put the person’s life at risk. The change must be controlled and, if necessary, a surgical or endovascular procedure should be carried out. 

Valve diseases
One of the most frequent appointments at the unit is for disease in one of the four heart valves. The disease is diagnosed with an echocardiogram. The heart’s valves may deteriorate due to ageing, infectious illnesses or some congenital cause. The deterioration may cause narrowing of the valve opening. This prevents the blood from circulating properly. It may also cause incorrect closure which makes the blood go backwards, instead of moving on in the blood system. Currently, early diagnosis, follow-up and suitable treatment enable a valve diseases to be solved or improved to a considerable extent. 

The main treatment for valve disease is the surgical implant of a mechanical or biological prosthesis. Over the last decade implantable prostheses and devices have been developed to repair valves using catheterisation. This is a simple technique that is minimally invasive.

 

Treatments and diagnostic tests related to this speciality

Transthoracic echocardiogram
This studies the morphology and function of the heart using ultrasound. It is a non-invasive test, with no side effects and highly effective in diagnostics using imaging in cardiology. It enables a detailed study to be made of the heart walls’ mobility, the valves and the blood flow within the heart. Echocardiography currently uses 3D technology. This allows the heart to be studied from a more real perspective and improves the diagnosis.

Transoesophagal echocardiogram
This test also studies the morphology and function of the heart using ultrasound. In this case, it is done using a probe in the inside of the oesophagus. The patient needs to be sedated. The advantage of this test is the high resolution image it gives, which is much higher than conventional echocardiography. For this reason, where there are doubts about a diagnosis, both are done.

Transthoracic stress echocardiogram
This test also studiesthe morphologyandthe function of theheartusingultrasound. In this case,it is done with the patient pedalling a staticbicycle.It enables assessmentof the increase in coronary blood flowin patientswithischaemiccardiopathy.During the test, theelectrocardiogram andbloodpressurearecontinuouslymonitored.Thetestprovidesinformationabout possibleobstructions ofthecoronaryarteriesand, in some cases,aboutthe function of thevalves.

Multi-detector computed tomography
This technique uses X-Rays to provide multiple images of cuts or sections of the body, including the heart. A computer program puts the images obtained together again and creates a 3D view of the heart which enables precise exploration of the coronary arteries, the aorta, valve prostheses or abnormal intracardiac communications. 

Cardiac MRI
This technique also provides images of sections of the heart and the main arteries in the body. It does not use X-Rays. However, it is not advisable for patients with chronic kidney failure or implanted heart devices. It provides information about the heart’s structure and allows precise imaging of its tissue. It determines whether the heart’s tissue is made up of, or occupied by, dead cells, fibrous tissue, fat or liquid.

 

Research

The research group at the Echocardiography and Cardiac Imaging Unit has an excellent reputation in its field in Spain, Europe and worldwide. The research programme mainly receives external, highly competitive finance. It works to get to know more about heart disease and, therefore, improve people’s health care. The research group works with some organisations, such as the association of patients affected by Marfan’s syndrome (SIMA) and the José Durán Spanish Sudden Death Society.

Research is an area of work that is well consolidated and multi-disciplinary. It creates original ideas and moves forward with technological improvements. Over the past few years, the group's engineering team has developed several innovative clinical imaging analysis tools to get to know about and solve important problems. It has also published several articles in scientific journals and has taken part in several clinical trials, and multi-centre logs and research. The group also actively collaborates in projects associated with Barcelona University and Pompeu Fabra University. The unit is currently coordinating: 

  • four Spanish projects: FIS and RETOS
  • five European projects: Discharge, Cardiateam, iModern, EIT Health and CT-Pro
  • an international log: Pfizer in cardiac amyloidosis
  • five clinical trials BICATOR, LOAT, IONIS, ARRAY and DAPA-Moda

The members of the unit are a part of the European Cardiology Society’s Aortic Disease Group, the European Association of Cardiovascular Imaging (EACVI) and the American Society for Cardiovascular Magnetic Resonance (SCMR).

 

Education 

The training programme includes:

  • a specialist medical programme in Cardiology 
  • for the bachelors, masters and doctorate students at the Universidad Autónoma de Barcelona (UAB) 
  • sub-specialities within the Cardiology speciality 
  • an international grants programme 
  • internationally renowned weekly scientific seminars 
  • continuous medical training 

The individual members of the unit regularly take part in training activities outside the hospital. They run masters courses in cardiovascular disease, and collaborate on them. Each year the unit organises two echocardiogram courses and a meeting on cardiac MRI and CAT. 200 experts from all over the world take part in these events.

 

Experts

The Echocardiography and Cardiac Imaging Unit is made up of medical, nursing, engineering and administrative personnel, as well as technical and support staff. It works closely with other sections of the Cardiology Department and with the other hospital departments. Furthermore, over the past few years, three people with a degree in engineering have joined who are specialists in fluid dynamics. 

The medical staff consists of a coordinator and seven assistants. The nursing team consists of four specialist experts. The technical team has four experts, qualified with a specific masters from the Spanish Cardiology Society. 

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