Transforming Heart Failure Management: The Power of Strain Imaging, 3D Imaging, and Vortex Analysis in Echocardiography

Figure 1. Two-dimensional and three-dimensional LVEF valuation. In presence ofminimal differences in the ejection fraction measurement, the indications for medical therapy or possible resynchronization therapy can shift. In this case, the volumes were measured both with the 2D and 3D Simpson’s methods of disks (MODs). Panels (A,B): the left ventricular (LV) ejection fraction is 38%, measured with the MODs. The volumes in diastole and systole are 110 mL and 67 mL. Panels (C,D): the MODs in the two-chamber view. In diastole and systole, the volumes are, respectively, 107 mL and 66 mL. Panels (E,F): LV ejection fraction of 40% with volumes of 73 mL and 122 mL. Although the ejection fraction was similar, there was a difference in the volumes, underscoring a likely systematic error in measuring the volumes in two-dimensional method.

Figure 2. Possible applications of 3DE. Panel (A) shows a 3DE image “full volume” for the left ventricular volume; the orthogonal views confirm wall motion abnormalities in any given segment. Panel (B) shows the 3D left ventricular volume and function. Panel (C) shows the 3D right ventricular volume and function. Panel (D) shows the 3D left atrium volume and function.

Figure 3. Three-dimensional image of mitral valve surgical atrial view. Panel (A) shows normal mitral valve with 3D echocardiography evaluation; panel (B) showsprolapse of mitral valve scallop P2; panel (C) shows normal mitral valve with TrueVue view modality; and panel (D) GlassVue view of normal mitral valve (LAA, left atrial appendage; AV, aortic valve; IAS, interatrial septum; AML, anterior mitral leaflet; and PML, posterior mitral leaflet).

Figure 4. Myocardial strain valuation. Panel (A) shows the auto ejection fraction calculation with a good quality apical acoustic window of the endocardial edges with artificial intelligence technology that allows semi-automatic recognition; in this image, the LVEF = 60%. Panels (B,C) show a 2D left ventricular echocardiography with speckle tracking with a normal global longitudinal strain (GLS) in the range of −21.7%. Panel (D) shows a normal global longitudinal strain (GLS) of −20% and a normal myocardial work index of 1548 mm Hg%.

Figure 5. Vortex geometric analysis. A normal (one the right) versus a pathological (on the left) subject with aortic stenosis. The geometric values to consider are area, depth, and length. The area is identical in both the normal and pathological subjects. The depth varies between the two, with the normal subject having a smaller depth. This suggests that the aortic stenosis pushes the structure towards the tip in the normal subject. The length is the same in both subjects.

Figure 6. Normal vs. pathological subjects with aortic stenosis. The vortex’s energetic values to consider are the following: vortex intensity, local dissipation, and kinetic energy. The vortex intensity varies, with the normal subject exhibiting a higher intensity, compared to the pathological subject, who shows a greater local dissipation.