Contrast enhanced real-time three-dimensional echocardiography for quantification of myocardial perfusion: a step forward

Abstract

Many studies have shown the feasibility of contrast two-dimensional echocardiography (2DE) for myocardial perfusion imaging.1 The technique offers several important advantages over competing techniques including its wide availability, portability, low cost, no radiation concern, and the simultaneous visualization of wall motion and perfusion. However, contrast echocardiography has not become a routine procedure both for the diagnosis and assessment of ischaemic heart disease in daily practice. There are several reasons for this: no echo contrast agent has been specially approved for myocardial perfusion imaging, there are concerns about safety and reimbursement issues. In addition, it is well recognized that 2D images of the heart do not provide accurate information on both the extent and severity of myocardial perfusion defects. Theoretically, 3D imaging allows a more accurate assessment of the myocardial perfusion defects but its use and advantages in patients could not be explored until the development of real-time three-dimensional echocardiography (RT3DE). This technique allows to capture the entire myocardial volume during a single contrast injection, thus obviating the need of repeated injections of boluses of a contrast agent during sequential consecutive acquisition of multiple 2DE planes needed for off-line …