Three-dimensional speckle tracking echocardiography: a novel approach in the assessment of left ventricular volume and function?

Over the last decades, echocardiography has developed to be an established non-invasive imaging technique, widely available for cardiovascular investigation. Determination of myocardial function is vital for the clinical evaluation of cardiovascular diseases. Altered cardiac function can be detected with echocardiography as regional myocardial wall motion abnormalities, changes in left ventricular volumes and global left ventricular dysfunction.1 Regional wall motion abnormalities can identify and quantify areas of previous myocardial infarction. Visual assessment categorizes wall motion on the basis of the (i) degree of endocardial excursion, (ii) degree of endocardial thickening during systole, (iii) timing of motion, and (iv) shape of the left ventricle. Timing is particularly important and accurate wall motion assessment requires a frame-by-frame review to overcome the limited temporal resolution of the human eye.2 Although there is tremendous variability in the coronary artery blood supply to the myocardium, a model with 16-segments assigned to one of three major coronary arteries is recommended for visual interpretation of regional wall motion.3 Therefore, individual myocardial segments can be assigned to one major coronary artery with recognition of anatomic variability. Normally, the endocardium thickens during systole; however, ischaemic myocardium shows different patterns of wall thickening or even thinning during systole. Wall motion abnormalities at rest represent scar tissue (irreversible myocardial damage) or viable myocardium (reversible myocardial damage).