Feasibility of Using Multiplane Stress Imaging to Add Measurement of LV Ejection Fraction Response to Exercise to Regional Wall Motion Scoring During Stress Echo

Abstract

Multiplane 4D imaging probes not only increase accuracy of stress echo by reducing image acquisition time whilst maintaining orthogonal triplane views, but also have the potential to add a biplane ejection fraction (LVEF) measurement to the standard regional wall motion scoring. Methods: We prospectively studied 67 consecutive patients undergoing a treadmill stress echocardiogram using a Bruce protocol. Multiplane images of the left ventricle were obtained at rest and post exercise using a GE Vivid 9 scanner and a 4D multiplane probe. All studies were performed by a single senior sonographer. The time taken to obtain the images post exercise was recorded and the LVEF measured off line using EchoPac™ BT12 software and Simpson's biplane method. Results: We included 67 patients (52 male, 15 female) over 12 months, ranging in age from 28 to 85 years, (63 ± 11 years, mean ± SD). The patients’ sizes varied with BSA ranging from 1.53–2.38 m2 (mean 1.92m2). Images suitable for standard regional wall motion scoring were obtained in 95%, within 35 ± 9 seconds, and the LVEF was measurable in 100% of these patients. Conclusion: Left ventricular ejection fraction response to exercise could be measured using multiplane 4D imaging in all patients with suitable stress echo images. Whilst the clinical utility of this will depend on the context in which it is used the results do suggest that it is feasible to incorporate this into standard stress echo protocols and may add important information to regional wall motion scoring.