Abstract
Real-time three-dimensional (RT-3D) echocardiography has entered the clinical practice but true incremental value over standard two-dimensional echocardiography (2D) remains uncertain when applied to stress echo. The aim of the present study is to establish the additional value of RT-3D stress echo over standard 2D stress echocardiography. We evaluated 23 consecutive patients (age = 65 ± 10 years, 16 men) referred for dipyridamole stress echocardiography with Sonos 7500 (Philips Medical Systems, Palo, Alto, CA) equipped with a phased – array 1.6–2.5 MHz probe with second harmonic capability for 2D imaging and a 2–4 MHz matrix-phased array transducer producing 60 × 70 volumetric pyramidal data containing the entire left ventricle for RT-3D imaging. In all patients, images were digitally stored in 2D and 3D for baseline and peak stress with a delay between acquisitions of less than 60 seconds. Wall motion analysis was interpreted on-line for 2D and off-line for RT-3D by joint reading of two expert stress ecocardiographist. Segmental image quality was scored from 1 = excellent to 5 = uninterpretable. Interpretable images were obtained in all patients. Acquisition time for 2D images was 67 ± 21 sec vs 40 ± 22 sec for RT-3D (p = 0.5). Wall motion analysis time was 2.8 ± 0.5 min for 2D and 13 ± 7 min for 3D (p = 0.0001). Segmental image quality score was 1.4 ± 0.5 for 2D and 2.6 ± 0.7 for 3D (p = 0.0001). Positive test results was found in 5/23 patients. 2D and RT-3D were in agreement in 3 out of these 5 positive exams. Overall stress result (positive vs negative) concordance was 91% (Kappa = 0.80) between 2D and RT-3D. During dipyridamole stress echocardiography RT-3D imaging is highly feasible and shows a high concordance rate with standard 2D stress echo. 2D images take longer time to acquire and RT-3D is more time-consuming to analyze. At present, there is no clear clinical advantage justifying routine RT-3D stress echocardiography use.
Highlights
Two-dimensional dipyridamole stress echocardiography, is an established and validated method for both the diagnosis and prognosis [1,2,3,4,5] of patients with known or suspected coronary artery disease
Patient population The study population consisted of 23 consecutive patients with known or suspected coronary artery disease referred for clinically indicated stress echocardiography
Patients were prospectively enrolled in Ospedale di Savona, Italy with the following criteria: age ≥ 18 years; adequate echocardiogram to assess regional wall motion in 2D and RT-3D
Summary
Two-dimensional dipyridamole stress echocardiography, is an established and validated method for both the diagnosis and prognosis [1,2,3,4,5] of patients with known or suspected coronary artery disease. Grounds for an accurate interpretation in stress echo rest on two important features: first-acoustic windows that permits complete endocardial border visualization within proper planes of left ventricle (LV) and secondly-prompt acquisition of peak images pertaining predictive accuracy. The three-dimensional echocardiography (3D) has the theoretical potential to more completely assess LV [8,9,10,11,12] but previous 3D imaging system were tedious techniques that used off-line reconstruction of multiple 2D images [8,9,10], not suitable for stress echocardiography. RT-3D, a much more user-friendly technique, permits single-window and single-heart beat acquisition of complete LV segments in a volumeshaped cineloop [6], having the prerequisite to employed during stress echo. The aim of the present study was to assess the additional value of RT3D over conventional 2D dipyridamole stress echocardiography
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