[The best of 2001. Echocardiography]

The year 2001 will be characterised by the confirmation of the essential place of harmonic imaging in echocardiography, a technique which has improved in a very important fashion the definition of the endocardial contour, thus giving a more reliable analysis of the segment kinetics, as much at rest as during a physical or pharmacological stress. The advances in the field of stress echocardiography essentially give confirmation of the excellent prognostic value of this technique, either post-infarction or in chronic coronary disease, including hypertensive patients, and with left ventricular hypertrophy or a conduction disorder. The aspirations of a more quantitative approach to regional myocardial function with the aid of myocardial tissue Doppler have been partly confirmed, even if no simple parameter can yet provide information of the presence of myocardial segment viability or ischaemia. The contribution of Doppler echocardiography in the unraveling of left ventricular diastolic insufficiency is crucial, with the description of parameters allowing characterisation of the type of left ventricular diastolic function anomaly and non-invasive evaluation of the filling pressures. The advances in transoesophageal echocardiography have essentially provided a better characterisation of the thrombo-embolic risk markers in atrial fibrillation and in the search for a cardiac source of embolus. Valuable information has equally been provided in acute aortic pathology particularly in the description of symptomatology and evolution of isthmic ruptures of the aorta. The first images of transthoracic echocardiography with real time three-dimensional reconstruction have finally been presented, allowing a glimpse of the enormous possibilities of this method, compared to recorded reconstruction which is routinely performed, especially in transoesophageal echocardiography. Though myocardial contrast echocardiography continues to induce very many fundamental publications, the clinical applications are slow to convince, facing the difficulties of proposing an adequate treatment and standardising the image, and an interpretation which takes account of physiological parameters (coronary micro-circulation).