Carolinas HealthCare System

Echocardiography is a non-invasive modality that provides images of the heart and great vessels using ultrasound waves. Two-dimensional echocardiography (2-D echo) and motion-mode echocardiography (M-mode echo) are used to assess cardiac structures and function. Using Doppler technology along with 2-D echo, it is possible to observe blood flow through the heart and valves and provide information regarding hemodynamic parameters, indices of cardiac function, and documentation of cardiac anatomy. Ejection fraction, estimated right heart pressures and assessment of valvular stenosis and regurgitation are examples of the type of information that is obtained from echocardiography.

Several echocardiographic modalities are performed in this laboratory including Transthoracic Echocardiography (TTE), Transesophageal Echocardiography (TEE) stress echocardiography (SE) and three dimensional (3-D) echocardiography.

TTE is the most common type of echocardiogram and involves placing coupling gel and an ultrasonic transducer on the patient’s chest. TTE may also be referred to as a regular echo or as a surface echo.

TEE is a type of echo where a specialized endoscope with a sound-wave producing transducer on the tip is placed in the patient’s esophagus and images are obtained of the heart. Because the heart lies in close proximity to the esophagus, the images from a TEE are often more accurate when interrogating valve structures.

SE is used to determine left ventricular function before, during, and after stress. Patients undergo a resting transthoracic echocardiogram and then either walk on a treadmill, pedal an ergometer, or receive a drug such as Dobutamine in order to increase their heart rate. Once they have reached an age predicted heart rate, a second transthoracic echocardiogram is performed and compared to the resting echocardiogram to determine if wall motion changes have occurred.

3-D echocardiography was developed approximately five years ago and is used primarily when interrogating congenital defects in pediatric patients. However, one of the newest developments in echocardiography is live three-dimensional TEE. The images obtained with this technology allow physicians to view the heart from any angle and see it much as if one were actually holding the heart and slicing through the structures as needed.

Sanger Clinic's Cardiac Ultrasound laboratory is accredited by the Intersocietal Commission for the Accreditation of Echocardiographic Laboratories (ICAEL). The lab was one of the first of ten labs nation-wide that achieved accreditation and has maintained that accreditation status since the inception of ICAEL in 1996.

The laboratory is staffed by cardiologists, registered nurses and registered diagnostic cardiac sonographers. All staff members have received additional specialty training in echocardiography and have met rigorous standards allowing them to interpret echocardiograms, perform echocardiograms and provide excellent patient care.

Sanger Clinic's Echocardiography Lab is located on the third floor “L” wing of Carolinas Medical Center and is a part of Carolinas Heart & Vascular Institute. Both in-patient and out-patient services are offered and the laboratory participates in several research projects.

Research Interests

Patients with Previous Myocardial Infarctions and Low Ventricular Ejection Fraction: Evaluation, Characterization, History, and Observation of Patient Care (ECHO). A Prospective Registry, April 2002.

Surrogate Markers for Severe Pulmonary Embolism. Registry, August 2003-July 2004.

Everest I, Patients with Previous Myocardial Infarctions and Low Ventricular Ejection Fraction; Evaluation, Characterization, History, and Observation of Patient Care.

Everest II, Patients with Previous Myocardial Infarctions and Low Ventricular Ejection Fraction; Evaluation, Characterization, History, and Observation of Patient Care.

Multicenter Automatic Defibrillation Implant Trial – Cardiac Synchronization Therapy (MADIT-CRT)

An Open-Label Evaluation of The Safety and Efficacy of a Combination of Niacin ER and Simvastatin in Patients with Dyslipidemia (OCEANS). IND#65,187.

Definity 401. A Phase IV Open-Label, Randomized, Multi-Center Exercise Stress Trial to Examine The Effectiveness of Definity and Evaluate The Predictive Value of Contrast Stress Echocardiography In Patients Outcomes.

Atrio-VEntricular Junction Ablation Followed by Resynchronization Therapy in Patients with Congestive Heart Failure and Atrial Fibrillation (AVERT AF). 2008

Sanger Echocardiography Main Laboratory Staff

Geoffrey Rose, MD, FACC, FASE, Laboratory Medical Director
Cristy Kikkert, BS RDCS, FASE, Laboratory Administrative Director
Elizabeth Puha, RN, RDCS, Laboratory Technical Director

William Herndon Jr, MD, FACC, IAHA, FASE, FASNC,Echo Staff Physician
Theodore Frank, MD, FACC,Echo Staff Physician
Irvin Naylor Jr, MD, FACC,Echo Staff Physician
Sanjeev Gulati, MD, FACC,Echo Staff Physician
John Symanski, MD, FACC,Echo Staff Physician
Allyson Boyle, RDCS, Staff Sonographer
Jeffrey Cohen, RCS, RDCS, Staff Sonographer
Tara Fincher, AS, Staff Sonographer
Cheryl Glova, Staff Sonographer
Mary Beth Harter, AS, Staff Sonographer
Kristie Johnson, RDCS, Staff Sonographer
Sabrina Kiser, CMA, Staff Sonographer
Angela Landrum, RN, Staff Nurse
Moira Marrone, RDCS, Staff Sonographer
Heather McMillan, RDCS, Staff Sonographer
Shamonna Moss, CMA, Staff Sonographer
Timothy Rowe, RCS, Staff Sonographer
Dawn Suber, BS, RDCS, Staff Sonographer
Terri Tucker, RN, Staff Nurse
Adrienne White, RDCS, Staff Sonographer
Christal Wilson, AS, Staff Sonographer

Contact Information

Cristy Kikkert, BS, RDCS, FASE
704-355-4733 Fax

Recent Publications

Foster E, Wasserman HS, Gray W, Homma S, et al. Quantitative assessment of severity of mitral regurgitation by serial echocardiography in a multi-center clinical trial of percutaneous mistral valve repair. Am J Cardiology 2007; 100:1577-1583. [PMID: 17996523]

Silvestry FE, Rodriguez LL, Herrman HC, et al. Echocardiographic guidance and assessment of percutaneous repair for mitral regurgitation with the evalve MitraClip: Lessons learned from EVEREST I. J Am Soc Echocardiography 2007; 20:1131-1140. [PMID 17570634]

Kline JA, Hernandez-Nino J, Jones AE, Rose GA, Norton HJ, Camargo CA Jr. Prospective study of the clinical features and outcomes of emergency department patients with delayed diagnosis of pulmonary embolism. Acad Emerg Med 2007;14: 592-598. [PMID: 17554011]

Stevinson BG, Hernandez-Nino J, Rose G, Kline JA. Echocardiographic and functional cardiopulmonary problems 6 months after first-time pulmonary embolism in previously healthy patients. Eur Heart J 2007; 28: 2517-2524. [PMID: 17670755]

Kline JA, Hernandez-Nino J, Rose GA, Norton HJ, Camargo CA Jr. Surrogate markers for adverse outcomes in normotensive patients with pulmonary embolism. Crit Care Med 2006; 34: 2773-2780. [PMID: 16943732]