Role of real time 3D echocardiography in evaluating the left ventricle

Evaluation of left ventricular (LV) size and function are by far the most common reasons for performing echocardiography in the adult patient. Important diagnostic, prognostic, and treatment decisions rest upon LV morphology analysis; the widespread bedside availability, cost, and non-invasive nature of echocardiography has meant that this technique has become the method of choice in most situations for performing this analysis. However, both M mode and two dimensional (2D) echocardiography make important geometric assumptions about the LV which leads to inaccuracies in measurements. There is also poor inter- and intra-observer variability which limits the use of the technique in follow up of patients and also in scientific studies. Many echocardiographic departments perform “eyeball” analysis of global and regional LV function and provide visual estimates of ejection fraction because existing quantification methods (from M mode and 2D Echo) are both time consuming and difficult to perform. In an era when so many important and often costly decisions are made upon these data it is incumbent upon departments that accurate and reproducible echo quantification methods are utilised—especially since the “gold standard” technique of cardiac magnetic resonance (CMR) is not so widely available, is more costly, cannot be used on those with implanted pacemakers or defibrillators, and is disliked by many patients. Three dimensional (3D) echocardiography has been available for several years using time consuming and difficult reconstruction techniques (often utilising transoesophageal studies). However, recent advances in computer processing and transducer construction techniques have meant that real time transthoracic 3D echocardiography is now available from major ultrasound system manufacturers. Software programs to analyse 3D datasets of the LV are also now readily available; this combination of new instrumentation and software has been shown to provide highly accurate (compared to CMR) analysis of LV morphology and function, such that this methodology is likely to …