Echocardiography

The Yale Echo Laboratory is comprised of 9 board-certified cardiologists and over 17 registered cardiac sonographers performing transthoracic, stress, and transesophageal echocardiography using state-of-the-art equipment capable of 2D and 3D imaging, intracavitary contrast, and strain imaging. The lab actively supports rapidly growing programs within the section, including percutaneous aortic valve insertions, atrial fibrillation ablation, and left ventricular assist devices.  The lab has been digital for over a decade and has image management software that enables database search and off-line processing of 3D and strain images.

The echo lab strives to promote all three aspects of the academic mission - clinical service, research and education. Clinical service is provided to Yale-New Haven Hospital (YNHH), the West Haven Veterans Administration Medical Center (WHVAMC), and various outpatient facilities in the surrounding community.

Research by echo lab faculty covers a wide range of activities, including the Yale Echocardiographic Core Lab, which is part of the Yale Cardiovascular Research Group. Other clinical echo research includes clinical trials, collaborative multi-modality imaging studies, and clinical outcomes studies.  

Education for fellows is a primary mission for all faculty and staff within the Echo Lab. The volume and breadth of the lab offers more than sufficient training in the basics of echo for all fellows, with outstanding opportunities for advanced training for interested fellows. With the extent of research and clinical activities, we strive to inspire a new generation of academicians. 

Faculty

Jersey Chen, MD, MPH 
Farid Jadbabaie, MD, Director of the WHVAMC Echo Lab
Harlan Krumholz, MD, SM
Brian Malm, MD 
Arya Mani, MD
Robert McNamara, MD, MHS
Theresa Molisse, MD
Kerry Russell, MD, PhD, Associate Director of the Yale Echo Lab
Lissa Sugeng, MD, MPH, Director of the Yale Echo Lab

Research Activities

Faculty Interests in cardiac imaging are broad-ranging. 
  • Drs. McNamara, Krumholz, and Chen investigate cardiac outcomes and quality of care.
  • Dr. Sugeng has been integral in the development and evaluation of 3-Dimensional imaging, particularly related to valvular heart disease and left and right ventricular function.
  • Dr. Russell uses echocardiography on the mouse model to study cellular signaling and has established a Cardio-Oncology clinical and research collaboration.
  • Dr. Mani’s research in cardiovascular genetics is supplemented by imaging to characterize phenotypes. 

Yale Echocardiographic Core Lab (YECL)

Part of Yale Cardiovascular Research Group and directed by Lissa Sugeng, YECL provides echocardiographic core lab services for clinical trials involving drug or device therapies. Currently, there are several clinical trials overseen by YECL:
  • Parachute Trials (Cardiokinetix)
  • VIRGO
  • HELIX-HF (Biocardia)

Quality 

Harlan Krumholz, Robert McNamara, and Jersey Chen investigate quality and outcomes on a national scale. Locally, Robert McNamara and Rachel Lampert, from the Electrophysiology group, are conducting a study identifying potential candidates for intracardiac cardioverter defibrillators (ICD’s) with a notation on the echo report of patients with left ventricular ejection fraction less than or equal to 35%. 

Cardio-Oncology

Kerry Russell, along with Raymond Russell from the Nuclear Cardiology Group, directs the Cardio-Oncology collaboration with members from the Oncology section. Their expertise in cellular signaling and cellular metabolism facilitate translational research to improve investigation into the effects of various chemotherapeutic agents.

Three-dimensional Echocardiography

A pioneer in using and assessing 3D technology, Lissa Sugeng has brought valuable expertise to ongoing institutional efforts in assessment of myocardial function using of 3D strain as well as novel approaches to the assessment and treatment of valvular heart disease.  

Utilization

Jersey Chen, supported by NIH funding, assesses utilization patterns of various cardiovascular imaging modalities in attempt to gain insight into optimal medical decision making.

Support for other research

The Echo Lab provides support for other research efforts within the institution. Programs include those investigating hereditary hemorrhagic telangectasia (Osler-Weber-Rendu), Gauchers Disease, and first-pass radionucleotide validation. The Echo Lab also supports multiple efforts in therapeutic trials for eligibility and outcomes.

Clinical Activities

Yale Echo Lab services are performed at Yale New Haven Hospital (YNHH), West Haven Veterans Administration Medical Center (WHVAMC) and several out-patient facilities at Yale Physician’s Building (YPB), Branford, Guilford and Newington VAMC. Collectively, we perform over 15,000 transthoracic studies, 700 transesophageal echoes, and 2,000 stress studies per year.  Contrast echocardiography is actively incorporated in our echo protocol for technically limited studies.  Three-dimensional (3D) transthoracic echocardiography is used routinely for the assessment of left ventricular function. In addition, 3D TEE allows more defined assessment of patients with valvular heart disease - particularly for preoperative and intraoperative assessment of mitral valve prolapse, transcutaneous aortic valve implantation (TAVI), atrial septal defect and patent foramen ovale closure, and prosthetic valve disease. The lab provides exercise and dobutamine stress echo services for the evaluation of ischemic heart disease at YNHH, WHVAMC and outpatient sites. To support our percutaneous aortic valve program, dobutamine aortic stenosis studies are performed in patients with low gradient severe aortic stenosis. 

Yale Echo Lab has incorporated digital echocardiography for over a decade and is transitioning to Fuji Synapse, which not only allows traditional viewing, reporting, and archiving of echocardiographic studies but also will enable multimodality comparison and post-processing of 3D images and strain assessment. Our luminary relationships with Fuji Cardiovascular Imaging and TomTec promise to provide excellent opportunities to advance existing efforts in improving cardiovascular image processing.  

Educational Activities

All cardiology faculty are actively engaged in the educational mission of the echocardiography lab. All cardiology fellows are trained to meet at least the American College of Cardiology Level I requirements, including three months within the first two years in the Yale-New Haven Hospital and WHVAMC echo labs. Select fellows receive additional training to achieve Levels II and III. Cardiology fellows receive personalized instruction in developing their scanning skills by the experienced technologists who perform the lab's studies. All fellows become proficient in acquisition and interpretation of transthoracic imaging. Cardiology fellows provide preliminary interpretations for multiple studies per day on digital workstations within the reading room using an electronic reporting system. These studies are then reviewed with an attending cardiologist. Experience with transesophageal and stress echocardiography is also an integral part of the echocardiography rotations. Close relations exist with the pediatric cardiac service, including a program of echocardiographic imaging during percutaneous procedures, and the cardiac anesthesia service. 

In addition to hands-on clinical training, fellows attend didactic and case conferences. Multiple conferences are held each week with active participation by attendings, fellows, and sonographers. These conferences include cardiovascular imaging conferences, echo case conferences, and CME didactic conferences. Practical scanning sessions early in fellowship training facilitate performance and interpretation skills. Echocardiography is displayed prominently in the weekly Cardiology Grand Rounds and cardiology fellows’ conferences. In addition, fellows are encouraged to attend monthly cardiac anesthesia conferences and pediatric cardiology conferences. 

All faculty actively teach on the clinical services as well as give lectures to medical students, housestaff, physician assistant studies, and at affiliated teaching hospitals.

Web-based software created by the previous echocardiography director, Dr. C. Carl Jaffe, covering Adult Transthoracic and Transesophageal Echocardiography and Adult Congenital Heart Disease are available for individual learning.