A. Transthoracic Visualization of the Coronary Artery
In a pertinent review done in 2003, Drs. Gradus-Pizlo and Feigenbaum outlined the potential use of high-resolution, two-dimensional transthoracic echocardiogra-phy (HR-2DTTE) for visualization of the left anterior descending coronary artery (LAD). They indicated that the difference in the LAD wall thickness between patients with coronary artery disease and in patients with normal coronary arteries can be detected. Measurements of the LAD wall thickness with this method are larger than measurements obtained by intravascular ultrasound and histology. This thickness increases significantly with the development of atherosclerosis. This technique, when crystallized, could be recommended for the detection of subclinical atherosclerosis for which there are presently no adequate noninvasive applicable tests.
A noninvasive, reliable method to identify subclinical coronary artery disease in asymptomatic individuals at risk would be a dream come true and would add great dimen¬sions to our diagnostic armamentarium. HR-2DTEE and its refinements has this potential.
B. Handheld Instruments
Presently weighing about 5 pounds, these instruments are due to trim down to a one-pound weight and hopefully can be reduced further to 1 g in the future. Miniaturization using 3-D and 4-D parametric imaging can show areas of myocardial infarction. Ultrasound-guided focused abla¬tion technology for arrhythmias and other potentials are also on the horizon.