Use Of Three-dimensional Echocardiography Research Articles

Use of Three-Dimensional Echocardiography in the Analysis of Ventricular Function in Chagas Disease

Use of Three-Dimensional Echocardiography in the Analysis of Ventricular Function in Chagas Disease

Atrial functional mitral regurgitation: The concept has evolved, but inconsistencies still remain.

In our commentary we elucidated the fact that functional mitral regurgitation (FMR) is divided into two morphological subtypes: annular dilation with normal leaflet motion (Carpentier type I) and restricted systolic motion with left ventricular remodeling or dysfunction (Carpentier type IIIb). However, these phenotypes show some degree of overlap and there are currently no distinctive diagnostic cut-off values, therefore they may represent a continuum of the same disease. Moreover, correct left chambers quantification is critical for differentiating between atrial FMR and ventricular FMR. Three-dimensional echocardiography can quantify better leaflet areas, lengths, and closing angles, as well as the coaptation index, by eliminating geometric assumptions and integrating tethering of all leaflet surface and annular area enlargement. Also, It is expected that the use of artificial intelligence solutions and the deployment of automated onboard software that requires no or limited human input will stimulate wider clinical use of three-dimensional echocardiography in left chambers quantification.

Usefulness of three-dimensional echocardiography for the assessment of ventricular function in children: Comparison with cardiac magnetic resonance, with a focus on patients with arrhythmia.

Focusing on patients with arrhythmia, the aims of this study was to assess ventricular function in children using three-dimensional echocardiography (3D-ECHO) and to compare the results to those obtained with cardiac magnetic resonance (CMR). The study group consisted of 43 children in whom 3D-ECHO and CMR were performed. Twenty-five patients had a ventricular arrhythmia, 7 left ventricular cardiomyopathies, 9 proved to be healthy. In all children, 3D-ECHO (offline analysis) was used to assess ventricular ejection fraction (EF). The results were compared to CMR using the Bland-Altman analysis and linear regression. The Student paired T-test was used to compare of means between both modalities. The relation between the results derived from both methods is linear (for left ventricle: estimated slope = 1.031, p < 0.0001, R-squared = 0.998; for right ventricle: estimated slope = 0.993, p < 0.0001, R-squared = 0.998). In spite of minimal mean differences between results for both ventricles and narrow 95% confidence intervals, the paired t-test proved those differences not to be significant (p > 0.05) for the right ventricle but statistically significant (p < 0.05) for the left ventricle, for which the left ventricular EF calculated in 3D-ECHO was systematically underestimated with a mean difference of -1.8% ± 2.6% (p < 0.0001). Three-dimensional echocardiography assessment of both left and right ventricular EF in children showed high significant correlation and agreement with CMR. 3D-ECHO could be a valuable tool in follow-up of children with arrhythmic disorders requiring regular assessment of ventricular function.

Usefulness of three-dimensional echocardiography for assessment of left and right ventricular volumes in children, verified by cardiac magnetic resonance. Can we overcome the discrepancy?

IntroductionThe role of three-dimensional echocardiography (3D-ECHO) chamber quantification in children is still underestimated.Material and methodsIn 43 children 3D-ECHO measurements of end-diastolic (EDV) and end-systolic ventricular volumes (ESV) were compared to cardiac magnetic resonance (CMR) using Bland-Altman analysis and linear regression. The values of left and right ventricular volumes calculated in 3D-ECHO were compared with each other and verified by CMR.ResultsThe values of LV-EDV and LV-ESV measured in 3D-ECHO showed highly significant correlations with CMR (for LV-EDV r = 0.892, p < 0.00001; for LV-ESV r = 0.896, p < 0.00001). In the case of the right ventricle the correlation of 3D-ECHO results with CMR was still high (RV-EDV r = 0.848, p < 0.00001, RV-ESV r = 0.914, p < 0.00001), although mean RV-EDV and RV-ESV in 3D-ECHO were underestimated compared to CMR (by 38% for RV-EDV and 45% for RV-ESV). Correction of 3D-ECHO results using the coefficient of 1.38 and 1.45 for RV-EDV and RV-ESV, respectively, significantly improved the consistency of the results with CMR. 3D-ECHO offered lower mean values of right ventricular volumes compared to the left ventricle. The discrepancy was again reduced by the calculated coefficients.Conclusions3D-ECHO is a valuable tool for assessment of left ventricular volume, which strongly correlates and agrees with CMR. The right ventricular volumes calculated in 3D-ECHO tend to be significantly underestimated in comparison to CMR and corresponding left ventricular volumes obtained from 3D-ECHO. The use of coefficients developed by the study improves the consistency of right ventricular volumes measured by 3D-ECHO with results obtained by CMR and reduces the volumetric discrepancy between ventricles in 3D-ECHO.

EACVI survey on standardization of cardiac chambers quantification by transthoracic echocardiography.

To evaluate standard reporting of cardiac chambers size and function by transthoracic echocardiography (TTE), the EACVI Scientific Initiatives Committee performed a survey across European centres. In particular, the routine use of three-dimensional echocardiography (3DE) and speckle tracking-derived myocardial deformation imaging (STE) was explored. A total of 96 European Echocardiography Laboratories from 22 different countries responded to the survey, which consisted of 20 questions. For most of the standard parameters of cardiac chamber size and function, answers from the centres were homogeneous and demonstrated good adherence to current recommendations. In particular, all centres assessed left ventricular (LV) and left atrial (LA) size combining diameter measurements with volumes obtained using the bi-plane Simpson's method. More variability was observed in the measurements of the right heart chambers and thoracic aorta. Interestingly, >90% of centres had access to 3DE and STE; however, the large majority of centres reserved the use of these techniques for selected cases, particularly for the measure of 3D LV volumes and ejection fraction and global longitudinal strain in patients being considered for cardiac device implantation, surgical intervention (valvular heart disease) or screened for cardiotoxicity. Only 10% of centres used 3DE for right ventricular and LA volumes. Also, <30% of the centres used LA strain imaging. In Europe, a good adherence to current recommendations was observed for most of the standard parameters of cardiac chambers quantification by TTE. Advanced echocardiography modalities, such as 3DE and STE, are widely available but used only in selected cases.

The contemporary role of echocardiography in the assessment and management of aortic stenosis.

Aortic stenosis (AS) represents a major healthcare issue because of its ever-increasing prevalence, poor prognosis, and complex pathophysiology. Echocardiography plays a central role in providing a comprehensive morphological and hemodynamic evaluation of AS. The diagnosis of severe AS is currently based on three hemodynamic parameters including maximal jet velocity, mean pressure gradient (mPG) across the aortic valve, and aortic valve area (AVA). However, inconsistent grading of AS severity is common when the AVA is < 1.0cm2 but the mPG is < 40mmHg, also known as low-gradient AS (LGAS). Special attention should be paid to patients with symptomatic LGAS with low stroke volume and/or low ejection fraction because this entity is more difficult to diagnose and has a worse prognosis. Stress echocardiography testing plays an important role in this disease entity. Elderly patients with prohibitive comorbidities for surgical aortic valve replacement (AVR) were without procedural options until the advent of transcatheter AVR (TAVR), which has dramatically changed these circumstances. Along with computed tomography, echocardiography plays a vital role in the periprocedural assessment of the aortic valve and surrounding apparatus. This review describes the evolution of the role of echocardiography in the diagnosis and management of AS, the complexity of the aortic apparatus, and the increased need for expert use of three-dimensional echocardiography.

Which Cardiac Structure Lies Nearby? Revisiting Two-Dimensional Cross-Sectional Anatomy

Two-dimensional (2D) transthoracic echocardiography is one of the most used diagnostic tools in clinical cardiology. Similarly, 2D transesophageal echocardiography is considered an indispensable tool for cardiologists and cardiac anesthesiologists worldwide. However, because of their tomographic nature, both techniques display only thin cut planes of a given area of the heart, which are far from representing the "anatomic reality." It is widely accepted that experienced echocardiographers are able to reconstruct mentally a three-dimensional image of any cardiac structure on the basis of their interpretation of multiple tomographic slices. However, this may not be the case with less experienced echocardiographers. In particular, the authors noticed that less experienced echocardiographers are almost totally unaware of which structures lie "nearby" a given 2D tomographic plane, that is, what is adjacent in the elevation plane. In this article, the authors report the use of three-dimensional transesophageal echocardiographic images to discover which structures are located nearby (i.e., "behind" and "in front") the corresponding 2D cross-sections. The authors believe that this novel use of three-dimensional echocardiography is a unique aid to disclose what cannot be seen in a given 2D cross-section, thereby expanding our understanding of 2D echocardiographic anatomy. This may be an effective method to encourage all to "think" in three dimensions, even when they use 2D echocardiography.

Imaging of left-to-right shunt in adults.

Left-to-right shunts are commonly seen in congenital heart diseases. This review aims to review the anatomy, physiology, and imaging of the four most common left-to-right lesions in adults. Reported late complications of left-to-right lesions provide guidance in follow-up imaging. Use of three-dimensional echocardiography helps not only in the diagnosis of these defects but also in assistance during device closure. Noninvasive imaging plays a significant role in the diagnosis and management of left-to-right lesions.

P5509The use of three-dimensional echocardiography to measure left ventricular ejection fraction would increase the number of patients with indication to receive implantable cardioverter defibrillators

P5509The use of three-dimensional echocardiography to measure left ventricular ejection fraction would increase the number of patients with indication to receive implantable cardioverter defibrillators

Left-sided endocarditis extending to the right chambers: Usefulness of three-dimensional echocardiography in preoperative assessment

Left-sided endocarditis extending to the right chambers: Usefulness of three-dimensional echocardiography in preoperative assessment

Left-sided endocarditis extending to the right chambers: Usefulness of three-dimensional echocardiography in preoperative assessment

Left-sided endocarditis extending to the right chambers: Usefulness of three-dimensional echocardiography in preoperative assessment

Clinical Application of a 3-Dimensional Echocardiographic Automated Adaptive Analytics Algorithm to Quantify Left Heart Chamber Size and Function: Experience of a Single Tertiary Referral Centre in Western Sydney

Background: Current guidelines recommend the use of three-dimensional echocardiography for the quantification of left heart chamber size and function. However, a number of barriers, including the complexity and time-consuming nature of the analysis, prevent application of 3D echo techniques into routine clinical practice. We examined the utility of a recently validated automated algorithm that measures left atrial (LAV) and left ventricular (LV) volumes and ejection fraction in a busy clinical laboratory and compared this to standard 2D techniques; examining the accuracy and reproducibility of these measurements. Methods: 100 randomly selected patients (64 ± 16.3 years; 61% male) presenting for a transthoracic echo in our clinical service, and representing a range of left ventricular systolic function from normal to severe impairment (median LVEF 59%; minimum 11%, maximum 69%) were examined. 3D measurements of ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), LAV and stroke volume (SV) using the Philips HeartModel algorithm were compared to measurements using standard 2D techniques. Results: There was excellent correlation between 3D measurements of LVEF, LVEDV, LVESV, LAV and standard 2D measurements. Correlation between SV measured by 3D compared to 2D Doppler and volumetric methods were not as strong, with volumetric method showing better correlation. 3D measurements also showed good reproducibility for all measures. Conclusion: Our results demonstrate the feasibility of using the HeartModel 3D Automated Adaptive Analytics Algorithm as an accurate, reproducible and efficient method to quantify left heart chamber size and systolic function in a busy clinical service.Tabled 1Correlation coefficient (r)95% Confidence IntervalSignificance(p value)LVEF (%)0.920.88–0.95<0.0001LVEDV (ml)0.910.87–0.94<0.0001LVESV (ml)0.940.92–0.96<0.0001LAV (ml)0.940.92–0.96<0.0001SV by Doppler method (ml)0.530.37–0.66<0.0001SV by volumetric method (ml)0.760.66–0.83<0.0001 Open table in a new tab

Use of three-dimensional echocardiography in diagnosis of uni-leaflet mitral valve

Use of three-dimensional echocardiography in diagnosis of uni-leaflet mitral valve

Confirmed Usefulness of Three-dimensional Echocardiography in Mitral Valve Evaluation

Confirmed Usefulness of Three-dimensional Echocardiography in Mitral Valve Evaluation

Aortic stenosis: A routine diagnosis with a rare cause

A 40-year-old male patient presented with dyspnea on exertion and palpitation from 2 months ago. Physical examination revealed normal vital sign and a systolic murmur grade 3/6 in aortic area. Echocardiography revealed unicuspid aortic valve with an eccentric orifice, calcification, and aortic valve area of 0.9 cm2. This case report highlights the usefulness of three-dimensional echocardiography for the determination of number of aortic valve cusps, presence of raphe and morphology of valve.

MItral Valve Three-dimensional Echocardiography: Friend or Foe?

Three-dimensional echocardiography has widely transformed the world of cardiac imaging over the last decade. One of the most outstanding changes is that cardiologists have stopped believing dogmatically in formulas which, based on linear parameters, are able to calculate the area of different cardiac structures assuming a regular and symmetrical morphology and a single plane spatial arrangement. Multiple scientific evidence has been published against this method, since calculations based on this type of formulas can be quite different from real measurements. (1) Calculation of the left ventricular outflow tract for the assessment of patients with severe aortic stenosis is currently the most controversial example. Many discrepancies between parameters disappear with the use of threedimensional echocardiography. (2, 3) The mitral valve annulus is a fibrous ellipticallyshaped region which becomes more circular in diastole than in systole (4) and serves as attachment of the mitral leaflets. The annulus has a saddle-like contour and is not located in a single plane, but has portions called trigones which are closer to the ventricular apex, and middle parts of the anterior and posterior leaflets which are closer to the left atrial roof, the middle part of the anterior leaflet being slightly higher. Its normal average area is 7 cm2 and is modified during the cardiac cycle, increasing at end-systole and reaching its maximal dimension at end-diastole, (5) with an average 25% change in mitral valve area. Area reduction starts with atrial contraction, and is minimal during mid-systole. It is also important to know that the mitral annulus is displaced towards the atrium in diastole and towards the ventricle in systole. Once the mitral annulus characteristics are known, it is easy to understand the limitations of calculating the mitral annulus area by measuring its diameter in a single plane, a method usually employed to estimate the blood volume passing through it for further quantification of mitral or aortic regurgitant volumes. Three-dimensional echocardiography allows direct quantification of the area of any cardiac structure without using mathematical formulas. Therefore, we may say that the measurement is “more real” as it is not based on a geometrical approach. The technique is not free from limitations (1) and cannot replace twodimensional echocardiography in all cases; yet, it af-

The Role of Three Dimensional Echocardiography in the Detection of Cardiac Metastasis from Melanoma

Melanocarcinoma, considered the most malignant of skin tumors, with enormous potential for systemic metastasis mainly through the blood, usually occurs from 30 to 60 years of age. Its incidence increases progressively, affecting 4% to 8% of the white population2. Until recently, cardiac involvement was rarely diagnosed3. The limitations of imaging methods associated with nonspecific clinical symptoms made this diagnosis a challenge. Positron emission tomography (PET scan), together with the 3D TTE, plays an important role in palliative surgical planning, when recommended, as it provides detailed information of the tumor, such as size and invasion of adjacent structures. This case report describes the use of three-dimensional echocardiography for diagnosing cardiac neoplastic involvement due to melanoma, confirmed by PETscan, in a female patient with nonspecific symptoms.

Three-Dimensional Echocardiographic Assessment of Patent Foramen Ovale in Platypnea-Orthodeoxia

Platypnea-orthodeoxia is an uncommon syndrome characterized by positional dyspnea and hypoxia when upright that improves with lying down. We present a 75-year-old man with platypnea-orthodeoxia in the setting of a patent foramen ovale (PFO) and a 2.1cm highly mobile atrial septal aneurysm with 2cm bowing. Prior reports have established the use of three-dimensional echocardiography to facilitate percutaneous closure of PFO and atrial septal defect, but its use in patients with platypnea-orthodeoxia is unclear. We document three-dimensional echocardiographic images that accurately estimated PFO defect size and confirmed placement of the occluder device.

Three‐Dimensional Echocardiography in the Electrophysiology Laboratory

The use of three-dimensional echocardiography (3DE) during electrophysiology (EP) procedures is the end product of years of growth in two diverse cardiology subspecialties; namely, advanced cardiac imaging and the EP. During the past decade, progress in both fields has resulted in many important advances that have culminated in their union for a new area of growth and development. Imaging advances have provided the cardiovascular specialist with enhanced cardiac volume and function data, and more recently, 3DE capabilities with improved spatial and temporal resolution providing unprecedented spatial relationships. This latter development is valued by EP specialists in need of hitherto never required anatomic knowledge as they press forward with extraordinary expansion in their capabilities. It makes sense that by combining these two rapidly growing subspecialties, future capabilities in patient care may be achieved that would otherwise not be possible. This paper discusses the value of 3DE during EP procedures and offers the readers insight into this novel multispecialty hybrid arena. Using this model as a template, it is likely that the readers may identify other areas within their practices where periprocedural advanced imaging may afford significant dividends in patient outcomes.

Three-dimensional imaging of anomalous origin of the right coronary artery in a young athlete

We present a case of a 14-year-old male athlete to demonstrate the potential usefulness of three-dimensional echocardiography in supplementing magnetic resonance angiography in the assessment of actual anatomy in patients with anomalous origin of right coronary artery. Anomalous origin of the right coronary artery (RCA) from the left Valsalva sinus with an inter-arterial course between the great arteries is a …