Echocardiography in the Era of Multimodality Imaging

For over 30 of its 50-year history, echocardiography has provided noninvasive, widely available and inexpensive imaging. This technique now has a huge evidence base that is incorporated in the guidelines for many cardiac diseases, to the extent that echocardiography (2DE) has a central position in modern cardiac diagnosis and management. The paradox is that in contributing the lion's share of cardiac imaging, echocardiography has become removed from the province of the imaging specialist and its role as an interesting and worthwhile source of investigation and training has been superseded by the newer methodologies including cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR). However, the clinical contribution of potential advances are likely to be realised only if “advanced echocardiography” – including deformation, contrast and three-dimensional imaging – are differentiated from the “plain vanilla” of routine echocardiography. Successful translation of these advances into clinical practice will show that these new techniques are complimentary and in some cases competitive with the new imaging methodologies. This review seeks to provide a perspective of how echocardiography will integrate with the new imaging methodologies for the most common indications for cardiac imaging, with specific attention to the contribution of new methodologies including three-dimensional echocardiography (3DE) and deformation imaging.