The aim of the present study was to find out whether early cardiac changes in patients receiving chemotherapy can be detected by the conventional and deformation parameters of 2D and 3D echocardiography. Twenty-five healthy subjects with normal regional left ventricular function (group 1) and 25 patients receiving chemotherapy (group 2) underwent 2D and 3D transthoracic echocardiography (Toshiba Artida Medical System). All patients (group 2) were examined before and during cardiotoxic chemotherapy at a 3-month follow-up. Left ventricular volumes, ejection fraction, muscle mass, global longitudinal, global radial, global circumferential strain, and rotation were analyzed with 2D and 3D echocardiography, while twist and time-to-peak-intervals were analyzed with 3D echocardiography. For left ventricular volumes and muscle mass, no significant differences were seen between the two study groups (P<0.05). According to our results, myocardial dysfunction induced by cardiotoxic chemotherapy can be detected by 2D global radial strain. Detecting myocardial dysfunction by global longitudinal and circumferential strain requires more than 3 months follow-up. Changes in rotation, twist or time-to-peak intervals could not be verified at the 3-month follow-up in the present study. 2D global radial strain seems to be the most sensitive and robust parameter to detect early myocardial damage during chemotherapy. 3D echocardiography is not yet an established method to detect myocardial damage in clinical practice due to lower spatial and temporal resolution.

Comparison of 3D and 2D speckle tracking performed on standard 2D and triplane 2D datasets of normal and pathological left ventricular (LV) wall-motion patterns with a focus on the effect that 3D volume rate (3DVR), image quality and tracking artifacts have on the agreement between 2D and 3D speckle tracking. 37 patients with normal LV function and 18 patients with ischaemic wall-motion abnormalities underwent 2D and 3D echocardiography, followed by offline speckle tracking measurements. The values of 3D global, regional and segmental strain were compared with the standard 2D and triplane 2D strain values. Correlation analysis with the LV ejection fraction (LVEF) was also performed. The 3D and 2D global strain values correlated good in both normally and abnormally contracting hearts, though systematic differences between the two methods were observed. Of the 3D strain parameters, the area strain showed the best correlation with the LVEF. The numerical agreement of 3D and 2D analyses varied significantly with the volume rate and image quality of the 3D datasets. The highest correlation between 2D and 3D peak systolic strain values was found between 3D area and standard 2D longitudinal strain. Regional wall-motion abnormalities were similarly detected by 2D and 3D speckle tracking. 2DST of triplane datasets showed similar results to those of conventional 2D datasets. 2D and 3D speckle tracking similarly detect normal and pathological wall-motion patterns. Limited image quality has a significant impact on the agreement between 3D and 2D numerical strain values.

The strain values determined by 2D speckle tracking are significantly influenced by the tracking area width. The tracking of the subendocardial layers only results in lower global strain values than tracking the complete ventricular wall using the medium or wide tracking area widths. The tracking quality in the far field is worse if the tracking area is too wide. The present data show that standard and reference values of deformation imaging should include detailed information about the position and the width of the tracking area.

To our knowledge this is the first study focusing on methodological aspects - especially standardization - using speckle tracking and TVI. Due to the lower accuracy of strain calculation based on TVI in basal regions, foreshortening has no significant impact on quantitative parameters of TVI-derived strain values in normal contracting hearts. Using speckle tracking, however, foreshortening induces significant differences of basal septal strain in normal contracting hearts. In the presence of regional wall motion defects, a lack of standardization of the views will cause inhomogeneous patterns of regional strain depending on the scan planes through the center of the infarction or its penumbra. Thus, non-standardization will have a significant impact on deformation parameters in 2D echocardiography.

Mitral valve regurgitation is the most common valve defect after aortic valve stenosis in the industrialized world. Since it is not possible to directly determine the regurgitant fraction, it is often difficult to evaluate regurgitation at the heart valves with echocardiography.Introduction ! Mitral valve regurgitation can have different causes with the individual structural elements of the mitral valve being affected. These structures include the mitral valve annulus, the mitral leaflets, the chord strands, the papillary muscles and the entire left ventricle. The symptoms of mitral valve regurgitation are determined by the particular severity of the valve defect and largely by the cardiac reserve to compensate for this valve defect. Therefore, acute mitral valve regurgitation cannot be compensated and results immediately in the most severe clinical symptoms while chronic mitral valve regurgitation is typically well compensated and is associated with relatively mild clinical symptoms. In the case of compensation of chronic mitral valve regurgitation the left ventricular stroke volume is compensated in the early stage by an increase in ventricular emptying without dilatation of the left ventricle with simultaneous increase in the blood volume flowing back into the left atrium. This leads to a significant increase in the biplane left ventricular ejection fraction with normal ventricular dimensions. The heart compensates for the larger regurgitant volume due the worsening valve defect with a measurable increase in the size of the left ventricle and atrium with primarily still normal filling pressures and forward stroke volume. However, after exhaustion of the regulation mechanisms an increase of the degree of mitral regurgitation leads to a decrease of the forward stroke volume. In this stage the filling pressure of the left ventricle increases. As a result, there is regurgitation into the pulmonary circulation with an increase in pulmonary artery pressure values and compensatory hypertension of the right ventricle. In addition to the increase in ejection fraction and the enlargement of the left atrium and left ventricle, this condition can also be echocardiographically documented on the basis of an increased E/E' ratio and an increased systolic pulmonary artery pressure. The last stage of mitral valve regurgitation shows contraction insufficiency of the left ventricle with signs of more severe heart failure since the dilatation of the left ventricle outside the compensation region has transitioned to dilatation of the myocardium. In this stage the left ventricular ejection fraction is significantly reduced with an elevated E/E' ratio and increased systolic pulmonary artery pressures. The echocardiographic evaluation of mitral valve regurgitation should begin by questioning the patient as to whether he/she is currently experiencing symptoms and whether the symptoms are acute. If the answer to both questions is yes, there is high suspicion of acute mitral valve regurgitation. If for example acute dyspnea is reported ...