Three‐Dimensional Echocardiography in Evaluation of Left Ventricular Indices

Abstract

Accurate determination of left ventricular mass, volume, ejection fraction, and wall motion is important for clinical decision making. Currently, M-mode and two-dimensional echocardiography (2DE) have been routinely used for this purpose. Although these 1D or 2D modalities provide excellent diagnostic and prognostic information, they have a number of technical limitations including the time required to perform the procedure and operator-dependent image acquisitions. In addition, they are inherently limited by geometric assumption of three-dimensional (3D) left ventricular structures based on 2D slices. With the improvement in transducer technology and software development, 3D echocardiography (3DE) has become widely available. Left ventricular quantitation by 3DE has been demonstrated to be accurate by multiple studies that compared 3DE with reference techniques. In addition, 3DE measurements were found to be more reproducible and less variable than 2DE. Real time 3DE imaging has potential advantages in stress echocardiography including rapid acquisition, unlimited number of planes, avoidance of foreshortening, and precise segment matching. This is a major step forward in our diagnostic armamentarium for the evaluation of ischemia. In this review, we summarized the current evidence of 3DE for left ventricular evaluation.

Left Ventricular Ejection Fraction and Volumes: It Depends on the Imaging Method

“…With the use of contrast agents these differences in volume measurement have reduced, however, this is still not to the level where results can be considered interchangeable. Regarding volumes 3D ECHO has been demonstrated to show a large improvement toward the values of CMR, and as such, is the most accurate ultrasound technique for determining LV function, although the total number of patients included in trials is still small and very good acoustic windows are needed . The most promising technique in echocardiography is certainly contrast 3D, however, the excellent results demonstrated by the Jenkins group in 2009 could not be reproduced by Caiani et al., and so further investigation is required .…”

Reference Values for Real Time Three‐Dimensional Echocardiography–Derived Left Ventricular Volumes and Ejection Fraction: Review and Meta‐Analysis of Currently Available Studies

“…40 Finally, in previously reported studies, 3DE has shown to be a reproducible technique with optimal intra-and inter-observer variability. 3,41 Accordingly, studies included in the current work all had an optimal intra-and inter-observer variability. LV EF was the most reproducible parameter with excellent intra-and inter-observer variability.…”

“3D Fusion” Echocardiography Improves 3D Left Ventricular Assessment: Comparison with 2D Contrast Echocardiography

“…The delineation of the right ventricle remains challenging for all imaging modalities because of its complex geometry and it will be of value to determine whether fusion can improve right ventricular assessment. 3D echocardiography has been known from most papers as an excellent LV assessment tool . However, there are also some views of limited usability for 3D .…”

“…3D echocardiography has been known from most papers as an excellent LV assessment tool. [28][29][30] However, there are also some views of limited usability for 3D. 31,32 A recent multicenter study suggested that contrast application may be needed with 3D echocardiography as 2D echocardiography to reduce inter-reader variability for volumes and ejection fraction.…”