Conventional 2D Echocardiography Research Articles

Isolated Left Ventricular Noncompaction Mimicking Ventricular Mass

Isolated left ventricular noncompaction is an inherited cardiomyopathy characterized by multiple prominent trabeculations with deep intertrabecular recesses. The diagnosis is often missed because echocardiography poses inherent problems of poor echo window in assessment of the LV apex, which is most commonly involved in noncompaction. We report a case in which conventional 2D echocardiography failed to demonstrate multiple prominent trabeculations. Contrast echocardiography confirmed the presence of multiple trabeculations with deep intertrabecular recesses. This report emphasizes the importance of contrast echocardiography in the diagnosis of ventricular noncompaction.

088 Is there any improvement in 3D and 2D echocardiography determined left atrial volume following continuous positive airway pressure treatment in patients with obstructive sleep apnoea?: Abstract 088 Table 1

Background Previous studies have reported a higher incidence of diastolic dysfunction indices in obstructive sleep apnoea (OSA). Chronic diastolic dysfunction causes structural and functional remodelling of left atrium resulting in increase in left atrial volume (LAV). Long-term continuous positive airway pressure (CPAP), an accepted treatment for OSA, has been shown to lead to improvement in diastolic function in OSA. However, it is still not known if long term CPAP treatment causes reduction in LAV (representing chronic diastolic dysfunction) in such patients. Methods Accordingly, a total of 27 patients with moderate to severe OSA (aponea-hypopnoea index>15) were recruited. All patients underwent 3D echocardiography (3DE) for end-systolic LA volume calculation prior to CPAP treatment. LA volume was also calculated using conventional 2D echocardiography (2DE) methods (ie, elliptical and biplane area length). All OSA patients were then treated by CPAP (>20 weeks). 3DE and 2DE LAV measurements were repeated following successful CPAP treatment. Results Mean duration of CPAP therapy was 20 weeks. Significant reduction in LAV was noted by all three methods following CPAP therapy (abstract 088 table 1). Conclusion Long term successful CPAP treatment results in significant reduction in LAV, a marker for adverse prognosis, determined by 3D and 2DE techniques.

Mitral Valve Regurgitation and 3D Echocardiography

The mitral valve is a complex, dynamic and functional apparatus that can be altered by a wide range of disorders leading to stenosis or regurgitation. Surgical management of mitral valve disease may be difficult. Planned intervention may not always be feasible when the surgeon is faced with complex pathology that cannot be assessed fully by conventional 2D echocardiography. Transthoracic and transesophageal 3D echocardiography can provide a more reliable functional and anatomical assessment of the different valve components and evaluation of its geometry, which can aid the surgeon in planning a more suitable surgical intervention and improve outcomes. Although 3D echocardiography is a new technology, it has proven to be an important modality for the accurate assessment of valvular heart disease and in the future, it promises to be an essential part in the routine assessment of cardiovascular patients.

Simple Preimplant Identification of Optimum VV Timing before Cardiac Resynchronization Therapy: Tissue Doppler Imaging versus Conventional 2D Echocardiography

Optimum interventricular (VV) timing may potentially reduce the number of nonresponders to cardiac resynchronization therapy (CRT). We investigated whether optimum VV-timing interval could be determined before CRT implantation by means of tissue Doppler imaging (TDI) analysis and from visual assessment of conventional 2D echocardiography. Thirty consecutive patients prospectively underwent 2D, 3D, and TDI echocardiographic evaluation before and 1 month after CRT. By using 3D echocardiography, LVEF was found to be increased from 23.8 +/- 6% to 35.7 +/- 9% 1 month after CRT (P < 0.001). NYHA class improved from 3.0 +/- 0.6 to 1.8 +/- 0.6 (P < 0.001). In 93% (77-99% with 95% confidence limits) of the patients optimum VV timing was correctly predicted based on preimplant TDI identification of the region with delayed myocardial contraction. A similar result could be obtained in 83% (65-94%) of the patients simply by visual assessment of conventional black and white 2D echocardiography (ns). Preimplant TDI evaluation seems to be convenient for the determination of optimum VV timing. Further postimplant adjustment guided by TDI is hardly necessary unless patients do not experience clinical benefit. TDI may seem superior to visual assessment of dyssynchrony by means of conventional 2D echocardiography. However, this simple technique indicated optimum VV timing in the majority of cases in this study.

Three‐dimensional sonography in the prenatal diagnosis of aortic arch abnormalities

To assess the added value of 3-dimensional (3D) echocardiography with spatiotemporal image correlation (STIC) in the diagnosis of aortic arch abnormalities in fetuses with isolated abnormal upper thoracic 3-vessel view (3VV). A total of 3,420 women underwent a targeted anatomic survey at 18-22 weeks' gestation in a 1-year period. An isolated abnormal upper thoracic 3VV detected on 2-dimensional (2D) imaging was followed up by conventional 2D echocardiography and 3D fetal echocardiography with STIC. Offline reconstruction by a second operator blinded to the suspected diagnosis was performed. Neonatal echocardiography and MRI with 3D reconstruction were performed to verify the prenatal diagnosis. Of the 3,420 patients referred, 4 had an isolated abnormal 3VV (0.09%). A right-sided aortic arch (RAA, n = 3) and double aortic arch (DAA, n = 1) were suspected. In all aortic arch abnormalities, 3D fetal echocardiography and STIC correctly identified RAA with aberrant left subclavian artery in 3 cases and DAA in 1 case with a degree of definition that was equal to the confirmatory postnatal echocardiography and 3D MRI. Although the 2D upper 3VV is a powerful screening tool for isolated aortic arch abnormalities, 3D fetal echocardiography with STIC allows an accurate prenatal characterization of the abnormality to a degree that is typically attainable only by post partum imaging.

Developments in 3D Echocardiography

3D echocardiography (3DE) will gain increasing acceptance as a routine clinical tool as the technology evolves due to advances in technology and computer processing power. Images obtained from 3DE provide more accurate assessment of complex cardiac anatomy and sophisticated functional mechanisms compared with conventional 2D echocardiography (2DE), and are comparable to those achieved with magnetic resonance imaging. Many of the limitations associated with the early iterations of 3DE prevented their widespread clinical application. However, recent significant improvements in transducer and post-processing software technologies have addressed many of these issues. Furthermore, the most recent advances in the ability to image the entire heart in realtime and fully automated quantification have poised 3DE to become more ubiquitous in clinical routine. Realtime 3DE (RT3DE) systems offer further improvements in the diagnostic and treatment planning capabilities of cardiac ultrasound. Innovations such as the ability to acquire non-stitched, realtime, full-volume 3D images of the heart in a single heart cycle promise to overcome some of the current limitations of current RT3DE systems, which acquire images over four to seven cardiac cycles, with the need for gating and the potential for stitch artefacts.

Evaluation of a Novel Two-dimensional Echocardiographic Method to Measure Mitral Valve Area in Rheumatic Mitral Stenosis using a Simple Ellipse Calculation

Background: In clinical practice the use of conventional 2D echocardiography to measure mitral valve area (MVA) is associated with inaccuracies. Based on the assumption that the mitral valve orifice geometry is similar to an ellipse we evaluated a novel method of measuring MVA based on a simple ellipse area calculation.

How accurately, reproducibly, and efficiently can we measure left ventricular indices using M-mode, 2-dimensional, and 3-dimensional echocardiography in children?

Measurements of left ventricular (LV) size, mass, and function are the most common and important tasks for echocardiography in clinical practice and research in children with congenital and acquired heart diseases. There are little data to compare the utility of M-mode (MM), 2-dimensional (2D), and 3-dimensional (3D) echocardiographic techniques for quantification of LV indices. The objective of the study was to assess the accuracy, reproducibility, and efficiency of these echocardiographic methods for measurement of LV indices in children. A prospective study was conducted in 20 consecutive children (mean 10.6 +/- 2.8 years, 11 male and 9 female subjects) using conventional MM, 2D, and real-time 3D echocardiography (RT3DE). A Sonos 7500 system (Philips Medical Systems, Andover, MA) was used. M-mode and 2DE measurements were made according to the American Society of echocardiography recommendations. To include the entire LV for volumetric measurement, full-volume 3D data sets were acquired from 4 electrocardiogram gated subvolumes. The 3DE measurements were made off-line manually using 4-plane and 8-plane algorithms by 4D Echo-View (TomTec Imaging Systems, Munich, Germany) and a semiautomated algorithm by QLAB (Philips Medical Systems). Magnetic resonance imaging studies were also performed to determine the LV indices by a disk summation method based on the Simpson principle. The correlation and agreement between MM, 2D, and RT3D echocardiography and magnetic resonance imaging measurements are good (r = 0.81-0.97) for the 3 methods. The correlation was superior for RT3DE compared with 2DE and MM. The correlation and agreement were similar for the three 3DE methods. The intra- and interobserver variabilities ranged from MM (4.3%-4.8% and 7.0%-8.7%), 2DE (3.3%-4.5% and 5.5%-7.3%), and 3DE (0.4%-2.3%, and 0.2%-4.8%). The total time (acquisition and analysis) used for MM measurements was the least compared with 2DE and 3DE. The total time for 3DE using the semiautomated algorithms was not significantly different compared with that for 2DE. Our study showed that MM provides the most efficient assessment of LV indices but is the least accurate and reproducible technique compared with 2DE and 3DE. Three-dimensional echocardiography using both automated and manual analysis algorithm is superior to MM and 2DE for measurements of LV indices, and the automated 3DE algorithm is as efficient as 2DE. Therefore, 3DE using the automated algorithm is the method of choice for quantification of LV indices.

Live 3D Echocardiography with the Pediatric Matrix Probe

Three-dimensional echocardiography (3DE) enables new views of heart valves and the septa to be imaged. While the previous 3DE system was cumbersome, the recent introduction of live 3DE allowed for routine use of the technique in adult patients. Here, we report our initial experiences in adapting live 3DE and the adult matrix probe to the pediatric population. Thirty-four 3DE examinations were performed on children, aged 1 day to 12 years (n = 23; median 4 years) and fetuses 20-33 weeks in gestation (n = 11; median 25 weeks), many of whom had various congenital heart diseases. The pediatric matrix probe (2-7 MHz) was used for 2D, Doppler, and 3DE. New modalities of the Vision 2007 (Philips) were applied: live, full volume, thick slice, 3D color Doppler, the QLAB system for navigation, and cropping. The pediatric matrix probe allows for complete 2D and 3D echocardiography, and new acoustic windows are now available to perform live 3DE. The higher frequency of the probe increases the 3D image resolution obtained in neonates and fetuses. This advancement allows new views of the aorta, pulmonary valve, septa and intra cardiac anatomy to be captured. Real time 3DE is a feasible method in addition to conventional 2D echocardiography for evaluating congenital heart disease.

Real‐time 3‐dimensional echocardiographic features of fetal cardiac tumor

We present a case of fetal cardiac tumors diagnosed using conventional 2-dimensional (2D) fetal echocardiography and real-time 3-dimensional (3D) echocardiography. Conventional 2D echocardiography revealed multiple cardiac tumors involving the right atrium, interventricular septum, and right and left ventricles. Real-time 3D echocardiography with instantaneous volume rendering showed the cardiac tumors in motion. The advantages and disadvantages of real-time 3D fetal echocardiography are discussed.

Feasibility and Clinical Utility of 3D Echocardiography in Routine Practice

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

Clinical and echocardiographic determinants of ultrasound lung comets☆

Ultrasound lung comets (ULCs) are an echographic sign of extravascular lung water, that originate from water-thickened interlobular septa. To establish the echocardiographic correlates of ULCs. 340 in-hospital patients (68 +/- 12years, 115 females) admitted to adult cardiology department underwent upon admission a separate evaluation of chest ULCs and a comprehensive 2D and Doppler echocardiography assessment, including the degree of left ventricular diastolic dysfunction (from 0 = normal to 3 = restrictive pattern). A patient ULC score has been obtained by summing the number of ULCs from each of the scanning spaces in the anterior right and left chest, from second to fifth intercostal space. Multivariate linear regression analysis identified New York Heart Association (NYHA) class (OR = 2.1, CI = 1.4-2.9), ejection fraction (OR 0.954, CI = 0.928-0.981) and degree of diastolic dysfunction (OR = 2.438, CI = 1.418-4.190) as the only parameters independently associated to the number of ULCs. ULCs are a simple echographic sign of extravascular lung water, more frequently associated with left ventricular diastolic and/or systolic dysfunction. ULCs can usefully integrate the clinical and pathophysiological information provided by conventional 2D and Doppler echocardiography, in patients with known or suspected heart failure and dyspnoea as a presenting symptom.

Anwendungen der transthorakalen 3D-Echokardiographie bei angeborenen Herzerkrankungen

3D-echocardiography using a matrix array transducer was performed in 112 patients. In 98 patients (87.5 %) we were able to acquire adequate 3D-data. The mean time for the 3D-examination was 5.5 min. In valve lesions, septal defects and complex cyanotic heart disease 3D-echocardiography was a confident and helpful innovation for better assessment of the intracardiac morphology in pediatric patients. We conclude that 3D-echocardiography is a useful addition to the conventional 2D-echocardiography.

Complementary Role of Doppler Derived Coronary Flow Reserve and Left Ventricular Deformation Parameters in Detecting Myocardial Ischemia during Dobutamine Stress Echocardiography

Background: Coronary flow reserve permits the physiological assessment of coronary stenosis and could be complementary to the wall motion information derived from qualitative and quantitative dobutamine stress echocardiography. The aim of this study was to evaluate whether assessment of coronary flow velocity (CFV) and coronary flow reserve (CFR) in left anterior descending coronary artery (LAD) by transthoracic Doppler echocardiography (TTDE) adds diagnostic information to both conventional 2D and strain-based dobutamine stress echocardiography (DSE).

Comparison of real-time 3-dimensional echocardiography with conventional 2-dimensional echocardiography in the assessment of structural heart disease

We evaluated the diagnostic use of a real-time 3-dimensional (3D) echocardiographic system in 106 patients referred for echocardiography during a 4-month period. Real-time 3D echocardiography was performed and recorded in parallel with a routine, comprehensive 2-dimensional (2D) study. The diagnoses were exclusively on the basis of 2D findings. The 3D volumes were sliced offline in the 3 dimensions to selectively display specific cardiac structures and reviewed independent of the 2D findings. The 3D studies were graded as: A, new finding not on 2D studies; B, useful anatomic perspective; C, equivalent to 2D studies; or D, missed 2D findings. Compared with 2D echocardiography, 3D echocardiography was graded A in 7 (7%), B in 19 (18%), C in 65 (61%), and D in 15 (14%) cases. In the 26 grade-A and grade-B studies, mitral valve disease and congenital heart disease accounted for 16 (61%) cases. Suboptimal image quality was present in 7 (47%) of the 15 grade-D studies. Thus, real-time 3D echocardiography yields anatomic information comparable with conventional 2D echocardiography in the majority of patients. It can provide new and useful anatomic insight, particularly in patients with mitral valve disease and congenital heart disease. Suboptimal image quality remains a problem for real-time 3D echocardiography in some patients.

Real Time 3D Echocardiography Before and After Percutaneous Mitral Balloon Valvuloplasty

A 43 year old Latin American female underwent percutaneous mitral balloon valvuloplasty (PMV). The patient was evaluated by conventional 2D echocardiography and by Real time 3D echocardiography with real time volume rendering (RT-3D RTVR), before and after PMV. The utility of RT-3D RTVR in evaluating patients for PMV and its advantages over 2D are illustrated in this presentation.

3D Real-Time Imaging of the Fetal Heart

Objective: The aim of this study was to evaluate the clinical utility of a novel 3D scanner system for real-time 3D fetal echocardiography. Method: In a prospective study, 13 single, healthy 20- to 24-week-old fetuses were examined with conventional 2D and real-time 3D echocardiography. The visualization rates and imaging quality of standard cardiac views were compared between both methods. Results: The visualization rates of standard cardiac planes were found to be slightly increased and more easily obtainable in 3D imaging whereas the image quality showed better results with conventional 2D echocardiography. Conclusion: Our data show that real-time 3D fetal echocardiography can be considered a useful tool in the evaluation of the fetal heart with the necessity for further refinement of the resolution quality

New modalities of regional and global left ventricular function analysis: state of the art

Study of left ventricular (LV) regional and global function represents a main point of the cardiologic evaluation. This article presents an overview of the state of the art in quantitative analysis of ventricular wall motion and describes the different techniques available in clinical settings; we also present the personal experience of the authors in comparing conventional 2-dimensional (2D) echocardiography with other recently developed, more sophisticated techniques. Conventional 2D echocardiography mainly depends on the operator’s ability. Moreover, the physiologic regional pattern of myocardial wall motion in different segments of left ventricle is still not completely known as well as the heart’s rotational and translational movements. Qualitative and quantitative transesophageal echocardiography allows a better and more accurate evaluation of regional wall motion, and improves the on-line border detection feasibility even in patients with poor transthoracic echocardiographic window. The automated system for on-line endocardial border detection, color kinesis, and the power Doppler are, at the moment, promising techniques. Using magnetic resonance imaging as a “gold standard” for the study of global and regional left ventricular function, the investigators describe personal experiences with tissue Doppler imaging and a new computerized system for tissue Doppler images postprocessing analysis.

Serial assessment of left ventricular mass regression by 3D echocardiography requires three-fold fewer subjects compared to conventional 1D and 2D echocardiography

Serial assessment of left ventricular mass regression by 3D echocardiography requires three-fold fewer subjects compared to conventional 1D and 2D echocardiography

Three-dimensional Echocardiographic Volume Computation: In Vitro Comparison to Standard Two-dimensional Echocardiography

Two-dimensional (2D) echocardiographic methods for quantitative left ventricular volume computation have been shown to have a low predictive accuracy and reproducibility. To address the problem of geometric assumptions and image plane positioning errors inherent in 2D echocardiography, three-dimensional (3D) echocardiographic systems have been constructed that provide spatial registration and display of transducer-image position and orientation. Although 3D echocardiography has been shown to accurately measure volume in vitro and in vivo, only preliminary data exist demonstrating its superiority over standard 2D echocardiography. We calculated the volume of 30 water-filled latex balloon phantoms of varying size (40 to 200 ml) and shape using each method. Fifteen phantoms were nondistorted (ellipsoid or pear shaped); 15 were symmetrically distorted (dumbbell shaped). Although both 2D and 3D echocardiography showed an excellent correlation to the true volume (r = 0.97 and 0.99, respectively), the standard error of the estimate for 2D echocardiography was twofold larger than for 3D echocardiography (SEE = 6.7 ml and 3.52 ml, respectively). The true volume was slightly underestimated by 3D echocardiography (-2.83 ml), whereas 2D echocardiography overestimated a similar amount (+2.87 ml). The accuracy and variability for 2D echocardiography were significantly poorer (5.22% +/- 5.66% and 5.29% +/- 5.6%, p = 0.001 and 0.002, respectively) as compared with 3D echocardiography (3.7% +/- 2.65% and 2.65% +/- 1.9%, respectively). We conclude that 3D echocardiography with guided image plane positioning and a novel algorithm for volume computation (polyhedral surface reconstruction) achieves significantly more accurate and reproducible results than conventional 2D echocardiography with the modified Simpson's rule.(ABSTRACT TRUNCATED AT 250 WORDS)