[The best in 2000 on echocardiography].

The advances in Doppler echocardiography, like last year, concern the technology, the indications and the description of the natural history of cardiovascular diseases. The year 2000 will be remembered for the development of portable echocardiographs with two-dimensional and Doppler capabilities but without M mode, pulsed or continuous Doppler. These instruments weigh less than 3 kg and may be used at the bedside; however, problems of training personnel, reimbursement and availability of equipment remain. Myocardial contrast echocardiography has been the subject of many publications which validate continuous intravenous infusion of different contrast agents, which, coupled with techniques of image processing, suggest that quantification of regional myocardial perfusion at rest or during physiological or pharmacological stress may not be far off. The indications of stress echocardiography have increased: in addition to diagnostic and prognostic information in coronary artery disease, the applications of exercise and pharmacological inotropic stress echo extend to asymptomatic valvular regurgitation to detect infraclinical myocardial dysfunction before the usual Doppler echocardiographic parameters show significant changes. The value of Doppler tissue imaging in the assessment of regional myocardial function has been demonstrated: analysis of diastolic function with pulsed Doppler at the mitral annulus, quantification of regional myocardial function in different pathologies such as ischaemic heart disease and cardiomyopathy, validation of indices during stress echocardiography with the hope of a quantitative as well as a qualitative assessment, much improved since the introduction of harmonic imaging. Finally, Doppler haemodynamic evaluation has continued to substitute for cardiac catheterisation, now providing accurate indices of quantification of valvular regurgitation and description of the natural history of cardiac diseases, especially mitral regurgitation irrespective of its cause and aortic stenosis including cases with low output states. The continuing progress of ultrasound technology is therefore confirmed and provides an outlook into the third millennium: development of portable equipment, improved probe technology, use of instruments of quantification and extension of real time three-dimensional reconstruction, systems of image stocking and transmission and better orientation of its usage with the recommendations of scientific societies.