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The Origins of Echocardiography Programs

May 11, 2020

Interest in the study and understanding of heart disease began in the 1900s as social workers and physicians grew concerned about its increasing incidence, and the lack of treatment options. However, the techniques and technology for diagnosing it came much later.

Prior to the discovery of echocardiography, heart specialists explored the coronary arteries using catheters, which later evolved into left heart catheterization with coronary angiogram. This happened a few years after the American Heart Association was formed in 1924. Then, in 1958, a pediatric cardiologist named F. Mason Sones developed a technique that enabled him to produce high quality images of the coronary arteries for diagnostic purposes. Physicians also referred to the International Classification of Diseases as a diagnostic tool, and it is still in use today.

Like other diagnostic tools that make use of ultrasound technology, echocardiography owes its existence to Pierre and Jacques Curie, who discovered piezoelectricity. Piezo elements generate ultrasound waves that are used to create a picture of the heart called an echocardiogram or echo.

Echocardiograms let your doctor observe if your heart is beating and pumping blood as it should. They can use these echocardiogram images to identify heart disease. 

Here's how echocardiography emerged as a key diagnostic test in heart specialties.

Echocardiography  – a look back

Most narratives on the history of echocardiography would say that Harvey Feigenbaum, who is recognized worldwide as the "Father of Echocardiography," coined the term echocardiography. 

But if you ask Feigenbaum, he’ll beg to differ.

According to Feigenbaum, the term echocardiography first appeared in an article written by Dr. Bernie Segal of Philadelphia, although very little is known about Dr. Segal. Also, Feigenbaum said that if the term father in the realm of echocardiography meant that someone first used or introduced it, then the title didn't belong to him. That should be attributed to Dr. Claude Joyner, a cardiologist, and Prof. John Reid, an electrical engineer well-known for developing ultrasound apparatus for the medical field. In 1963, both had published a paper duplicating Dr. Inge Edler's mitral valve diastolic E to F slope technique in the evaluation of mitral stenosis — the narrowing of the mitral valve opening in the heart. 

In fact, between 1957 and 1965, Reid was already extensively working on echocardiography with Joyner, making and introducing the use of the first ever system in the United States. Reid constructed Joyner’s equipment capable of simultaneously displaying both the EKG and echocardiogram.

There are also claims that Dr. Inge Edler is the real father of echocardiography in relation to his work on mitral stenosis in the 1960s. Edler is said to have correctly identified signals originating from the mitral valve while studying a signal he attributed to the posterior wall of the left atrium. He was known to have performed ultrasound evaluations on dying patients.

Edler’s work was well-publicized and continued by cardiologists around the world, including the ones who developed two-dimensional, contrast, and transesophageal echocardiography using Doppler ultrasound which are now standard in cardiologic examinations. Even neurologists and obstetricians based in Sweden's Lund University were influenced by Edler to use ultrasound in their respective fields.

As Feigenbaum put it, he really was not the first to use cardiac ultrasound in the US, but he did resurrect echocardiography when interest in it waned. He also developed a technique that proved to be the first reliable diagnostic application of cardiac ultrasound.

In addition, Feigenbaum is respected for making cardiac ultrasound an essential clinical diagnostic tool and discipline in the field of cardiology. He is recognized for training several early pioneers in echocardiography, as well as the first cardiac sonographers. He pioneered and organized courses in echocardiography, and wrote the first and leading textbook on the subject matter.

Despite all the debate on who gets the title “Father of Echocardiography,” what’s really important is that these scientists continued to develop it, so all of us can benefit from their work. 

Echocardiography and heart health

Today, ischemic heart disease or coronary artery disease remains the No. 1 deadliest disease worldwide. With echocardiography programs, doctors are able to assess patients suffering from this disease with both diagnostic and prognostic accuracy in a safe manner.

Echocardiography is actually one of the services we offer at Champion Heart and Vascular Center. If you have any cardiovascular concerns, please make sure to get in touch with us.