Feasibility and Clinical Utility of 3D Echocardiography in Routine Practice

Abstract

BackgroundResearch studies have shown 3D echocardiography (3DE) to be a feasible and more accurate method of assessing LV volumes and ejection fraction when compared to conventional 2D echocardiography (2DE). However, there is limited information regarding the feasibility and incremental value of 3DE in clinical practice.MethodsUnselected patients referred to two hospital-based echo laboratories underwent 2DE and 3DE with measurement of acquisition and analysis time. Feasibility was defined by ability to measure LV parameters. Potential of 3DE to alter clinical decisions based on 2DE was evaluated by the ability to identify four clinically relevant measurement thresholds: (1) LVEF l 40% (indication for heart failure treatment); (2) LVEF l 35% (indication for ICD); (3) LV end-systolic volume (LVESV) g30 ml/m2 (prognosis post-MI); and (4) LVESV g 50 ml/m2 (indication for surgery in regurgitant valve disease).ResultsOf 168 patients, 3DE was feasible in 150 (89.3%) with 2D and 3D data available in 148 patients (88.1%). Time for 3D sample acquisition was 5.3 p 1.9 min. The proportion of patients in which 3DE changed categorisation above or below a threshold as defined by 2DE was 5.4% (8/148) for LVEF l 40%, 2.7% (4/148) for LVEF l 35%, 11.5% (17/148) for LVESV g 30 ml/m2, and 2.7% (4/148) for LVESVi g 50 ml/m2, with 82% of impact for EF in range 30n45% and 75% for LVESV in 20n40 ml/m2.ConclusionMeasurement of LV volumes and ejection fraction by 3DE is clinically feasible and has the potential to significantly alter clinical decision making.Copyright c 2007 Published by Elsevier Ltd. on behalf of The Australasian Society of Cardiac and Thoracic Surgeons and The Cardiac Society of Australia and New Zealand