Three-dimensional echocardiography to assess left ventricular geometry and function

ABSTRACT

Introduction: Quantification of left ventricular (LV) size and function represents the most frequent indication for an echocardiographic study. New echocardiographic techniques have been developed over the last decades in an attempt to provide a more comprehensive, accurate, and reproducible assessment of LV function.

Areas covered: Although two-dimensional echocardiography (2DE) is the recommended imaging modality to evaluate the LV, three-dimensional echocardiography (3DE) has proven to be more accurate, by avoiding geometric assumptions about LV geometry, and to have incremental value for outcome prediction in comparison to conventional 2DE. LV shape (sphericity) and mass are actually measured with 3DE. Myocardial deformation analysis using 3DE can early detect subclinical LV dysfunction, before any detectable change in LV ejection fraction.

Expert opinion: 3DE eliminates the errors associated with foreshortening and geometric assumptions inherent to 2DE and 3DE measurements approach very closely those obtained by CMR (the current reference modality), while maintaining the unique clinical advantage of a safe, highly cost/effective, portable imaging technique, available to the cardiologist at bedside to translate immediately the echocardiography findings into the clinical decision-making process.

KEYWORDS:

• Left ventricle
• ejection fraction
• myocardial deformation
• speckle-tracking echocardiography
• systolic function
• three-dimensional echocardiography
• diastolic function
• dyssynchrony
• mass
• shape

Article highlights

• The three-dimensional technique (3DE) has changed the paradigm in the echocardiographic assessment of LV geometry and function by actually measuring volumes, mass and shape and not calculating them from simple area and linear dimensions as with conventional two-dimensional echocardiography (2DE)

• 3DE allows the visualization/assessment of the anatomy of the whole left ventricle non being limited to a number of thin tomographic views as with conventional 2DE

• LV volumes and mass are more accurate, reproducible, and repeatable when measured with 3DE than when calculated by conventional (2DE)

• LV end-systolic volume and ejection fraction measured by 3DE have added prognostic power compared with the same parameters calculated by 2DE

• Novel, artificial-intelligence based algorithms for fully-automated detection of the endocardial border reduce the time needed to measure left ventricular volume and mass while improving reproducibility and repeatability of the measurements.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This article was not funded.