Patricia A. Pellikka, MD, FASE

On Saturday, November 3, 2012, the ASE Education and Research Foundation held its second Cardiovascular Ultrasound Technology and Research Summit, bringing together 43 echocardiologists, ultrasound engineers and physicists, and leadership from National Heart, Lung, and Blood Institute (NHLBI) and National Institute of Biomedical Imaging and Bioengineering (NIBIB) to discuss the cardiovascular ultrasound research and the technologic developments needed to meet future clinical needs. As co-chair of this event, I was pleased to be part of the animated discussion on topics ranging from research infrastructure to novel diagnostic and therapeutic capabilities of ultrasound, including sonothrombolysis, histiotripsy, 3D electromechanical wave mapping, and targeted drug and gene delivery using carrier microbubbles, to standardization of quantification methods. The dialogue also included methodologic, workflow, and technical issues which must be addressed to promote widespread adoption of 3D echocardiography and deformation imaging. Additionally, there was discussion about the need for an ongoing forum among the groups represented to facilitate continued progress, moving beyond proof of concept to translational research, and ultimately, improvement of patient care.

The ASE Foundation’s goal in supporting this event was three-fold: first, to bring echo research, with its breadth and enormous possibilities, to the attention of the NIH; second, to frame the perilous situation that exists due to the lack of federal funding available for echo research; and, finally, to bring the bright minds of industry together with scientists and clinicians to better explore and outline the possibilities for future breakthroughs in clinical care involving cardiovascular ultrasound.

Out of this event, we created a conceptual road map (see pages 325) highlighting our recommendations and goals for the future. I encourage you to read the article, which should excite you about the future applications of this vital technology. One of the most exciting topics discussed was the various therapeutic uses of ultrasound: to deliver genes and drugs; to lyse thrombus; and, with high-intensity focused ultrasound, to disintegrate other types of tissue. Therapeutic ultrasound is a new area for ASE, and one that I think we should support. Other participants at the Summit found other areas equally engaging, including Dr. Pam Douglas, co-chair of the Summit, who stated “We had a wonderful collection of almost 50 experts in ultrasound from academia, from industry, and from ASE, who talked about the real opportunities in ultrasound research for the next 5 to 10 years. We came up with a huge laundry list of things that we need to do, from improving the quality and standardization of 3D, to making sure that echo is well represented when compared with complimentary modalities, to fusion of images. It was a very exciting day.” Dr. Lissa Sugeng noted “We’ve progressed greatly with three-dimensional echo. However, from today’s proceedings, we can appreciate that that there needs to be higher image quality, better workflow to evaluate 3D images, and standardization of how to quantitate and report. I also think there is a great amount of advancement needed in terms of contrast perfusion, which has the potential for very novel applications, and I believe that there needs to be more development in fusion imaging for the future.”

It is crucial for us to recognize that federal funding for biomedical research has declined to critical levels. This is juxtaposed with phenomenal achievements and opportunities in medical science, as highlighted at our summit. If we want research in cardiovascular ultrasound to go forward, our society must help to support it financially. Research grants and travel stipends for abstract presenters are of great importance to attracting talented junior investigators to our field. Of course, we will look to obtaining cosponsorship from other interested foundations and corporations, and will continue to draw attention to our field with publications and communication with NIH leadership.

At the time of this publication, the ASE Board of Directors will have met at its annual retreat and discussed the ways the Society can support these types of imaging investigations. I believe the leadership will have made progress on deciding on the actions for the “laundry list” mentioned above. I think that it is important that ASE establish a council or other mechanism to facilitate the ongoing dialogue between basic and clinical scientists, engineers, and those involved with research funding. Basic and translational research on therapeutic ultrasound is needed, and we need clinical trials that document the impact of echocardiography on improving patient outcomes. But I also know that without additional financial support, many of the good ideas that we would like to support will be unrealized.

We have started our 2013 Annual Appeal for the Foundation and are now raising the funding to support future career development and cardiovascular sonographer research awards which are supported annually by the ASEF, as well as our next big research project. Past funding is already making a difference in some highly relevant areas. Proceeds from the 2011 and 2012 appeals have allowed us to support four career development awards and a cardiovascular sonographer research award, as well as our first reproducibility methodology grant, providing Foundation funding to address the perception of variability related to the use of echocardiography in clinical research, and assist in establishing standards to demonstrate the accuracy of cardiovascular ultrasound for quantifying research data. The outcome of this study is expected to document the important role of echocardiography within our changing healthcare environment, and its utility for clinical trials where large numbers of subjects must be imaged efficiently, reproducibly, and cost-effectively.

Research remains an important mission of ASE and the Society must find ways to continue to expand and advance this endeavor to meet the needs of our patients. Even with all that has been accomplished in echocardiography, and the breadth, depth and maturity of this field, it was obvious from the exciting discussion at the Summit that there is enormous potential still to be realized!