Three-dimensional speckle-tracking echocardiography: benefits and limitations of integrating myocardial mechanics with three-dimensional imaging

Abstract

Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is an advanced imaging technique designed for left ventricular (LV) myocardial deformation analysis based on 3D data sets. 3DSTE has the potential to overcome some of the intrinsic limitations of two-dimensional STE (2DSTE) in the assessment of complex LV myocardial mechanics, offering additional deformation parameters (such as area strain) and a comprehensive quantitation of LV geometry and function from a single 3D acquisition. Albeit being a relatively young technique still undergoing technological developments, several experimental studies and clinical investigations have already demonstrated the reliability and feasibility of 3DSTE, as well as several advantages of 3DSTE over 2DSTE. This technique has provided new insights into LV mechanics in several clinical fields, such as the objective assessment of global and regional LV function in ischemic and non-ischemic heart diseases, the evaluation of LV mechanical dyssynchrony, as well as the detection of subclinical cardiac dysfunction in cardiovascular conditions at risk of progression to overt heart failure. However, 3DSTE generally requires patient's breathhold and regular rhythm for enabling an ECG-gated multi-beat 3D acquisition. In addition, the measurements, normal limits and cut-off values pertaining to 3D strain parameters are currently vendor-specific and highly dependent on the 3D ultrasound equipment used. Technological advances with improvement in spatial and temporal resolution and a standardized methodology for obtaining vendor-independent 3D strain measurements are expected in the future for a widespread application of 3DSTE in both clinical and research arenas. The purpose of this review is to summarize currently available data on 3DSTE methodology (feasibility, accuracy and reproducibility), strengths and weaknesses with respect to 2DSTE, as well as the main clinical applications and future research priorities of this emerging technology.

Normal values of left ventricular rotational parameters in healthy adults—Insights from the three‐dimensional speckle tracking echocardiographic MAGYAR‐Healthy Study

“…In the present study, it was found that the feasibility of 3DSTE grew significantly as the operators gained experience. Our feasibility results are comparable to other groups …”

Three‐dimensional speckle tracking echocardiography: Is it the magic wand in the diagnosis of subclinical myocardial dysfunction in children with type 1 diabetes mellitus?

“…Moreover, LV systolic dysfunction in the form decreased LV EF obtained by 4D‐LVQ tool and decreased all cardiac strains were detected in the absence of cardiac symptoms. Feasibility and accuracy of 3D‐STE depend mainly on the quality of the images obtained that can be increased by choosing the sufficient frame rate, optimizing the gain, reducing the depth to include the entire LV cavity in the image sector, the acquisition of image during breath hold to avoid breathing artifacts and the choice of a well‐trained operator …”

“…To avoid these limitations, a 3D‐STE was recently developed to provide rapid image acquisition with a shorter scan time independent of operator skills due to simultaneous data analysis of different strains, LV volume and LV EF . Major disadvantages of 3D‐STE are that it mainly depends on the quality of the images, the patients’ cooperation for breath holding, and the regularity of the heart rate …”

Three‐dimensional speckle‐tracking echocardiography for evaluating myocardial motion in patients with cardiorenal syndrome

“…Two‐dimensional strain imaging cannot completely track the spatial position of speckles, and offers poor accuracy, whereas 3D‐STE traces their motion in three‐dimensional space without angle‐dependence. It can evaluate segmental myocardial strain from multiple directions and quantitatively evaluate regional or global ventricular function . It is also more accurate than 2D‐STE in evaluating myocardial function.…”

“…Two‐dimensional speckle tracking echocardiography (2D‐STE) has been proved to be a good method for evaluating myocardial deformation and cardiac function in patients with renal insufficiency . Three‐dimensional speckle tracking echocardiography (3D‐STE) appears superior to 2D‐STE in analyzing the whole myocardial deformation during the same cardiac cycle, and has been recommended by several authors . It is especially suitable in patients with CRS in whom coronary angiography is contraindicated.…”