Objectives The study aimed to assess the accuracy and reproducibility of the high‐definition blood flow imaging (HD‐Flow) in evaluation of left ventricular (LV) function by comparison with contrast echocardiography (Contrast). Background Contrast improves endocardial border visualization and assists in precise assessment of LV function. HD‐Flow, a novel ultrasound technique that enhances blood flow discrimination in LV, could possibly be used for improving endocardial border definition without contrast. Methods Eighty patients with technically limited transthoracic echocardiograms had HD‐Flow, and contrast performed sequentially. LV endocardial visualization, image acquisition time, wall motion, volumes, ejection fraction (EF), stroke volume (SV), and stroke volume index (SVI) were compared. Inter‐ and intra‐observer agreements were examined in a randomly selected subgroup. Results Both HD‐Flow and contrast significantly improved the percentage of the well‐defined endocardial border segments (71% at baseline vs 94.1% by HD‐Flow vs 94.9% by contrast, X2 = 401, P < 0.001). The acquisition time for HD‐Flow was significantly less when compared to contrast (2.13 ± 1.18 minutes vs 10.96 ± 3.51 minutes, P < 0.001). LV end‐diastolic volume (EDV), end‐systolic volume (ESV), EF, SV, and SVI measured by the two methods correlated well (EDVr = 0.97, ESVr = 0.96, EFr = 0.90, SVr = 0.77, SVIr = 0.74, all P < 0.001). In comparison, HD‐Flow was neither significantly different in detecting LV wall motion abnormality nor in EF, SV, and SVI measurements, but slightly underestimated LV volumes. Conclusions HD‐Flow imaging is feasible and user‐friendly in enhancing LV endocardial definition. This technique is useful in both qualitative and quantitative assessment of LV function.

Background: We recently reported the efficacy of High-definition blood flow imaging (HDI) in the assessment of left ventricular (LV) function and demonstrated that the results are comparable to those obtained by contrast echocardiography (CE). The present study validates HDI in measurements of LV volumes and ejection fraction (EF) by simultaneous comparisons with CE and cardiac magnetic resonance imaging (CMR). Methods: Eighteen patients (age range 25-79 years) with limited echocardiographic images had measurements of LV end-diastolic volume (EDV, mL), end-systolic volume (ESV, mL), and EF (%) by HDI, CE, and CMR. Results: Using the three techniques, measurements of EDV, ESV, and EF correlated well with correlation coefficients (r) ranging from .91 to .98 in comparisons between HDI and CMR, and .89 to .97 in comparisons between CE and CMR. The limits of agreement for the inter-methods comparisons by Bland-Altman analysis (mean ± 1.96

A 52-year-old male with a right ventricular mass that filled the entire right ventricle and assumed its shape was evaluated by two-dimensional and real time three-dimensional (3D) echocardiography. Contrast enhanced 3D imaging and quantitative assessments of the size of the mass were performed. The clinical correlation, the imaging characteristics of the mass, and the pattern of vascularity were consistent with metastatic hepatocellular carcinoma. The case illustrates the incremental role of 3D echo in defining the size, shape, spatial relationship, attachments, consistency, and vascularity of the right ventricular mass.

Segmental and quantitative estimation of Dobutamine stress induced ischemia is now possible by 3D subtraction contraction front mapping (CFM - bulls eye dynamic plot of LV contraction measured every 25 msec, TomTec). Parametric 3D images of the LV segments were obtained at baseline and at peak Dobutamine stress in 68 pts (age 45 – 89 yrs). SDI (standard deviation of the time to peak contraction in 16 segments) and % delayed segments (% pixels activated after peak global systolic volume) were measured. Stress and baseline maps were subtracted pixel by pixel to obtain a subtraction CFM for measurement of stress induced ischemia. Figure shows baseline, peak stress and subtraction contraction front maps; blue - normal activation, red - delayed activation, purple - stress induced ischemia. Out of 45 pts with CAD, stress induced LV wall motion abnormality was seen in 2D Dobutamine stress echo in 34 pts (sensitivity 75%) compared to a > 10% increase in 3D SDI in 32 pts, (mean ± SD, SDI, 0.55 ± 0.4 at baseline, 0.63 ± 0.03 at peak, sensitivity 71%). In 23 pts without CAD, SDI decreased from 0.53 ± 0.02 at baseline to 0.3 ± 0.02 at peak, 2D DSE was negative in 21 pts and nondiagnostic in 2 pts. Percent ischemic segments (difference between stress and baseline segmental activation shown in purple in the subtraction map) were 9.62 ± 4.2 in pts with CAD compared to − 0.37 ± 3.48 in pts without CAD (p < 0.01) Dobutamine stress induced delay in LV segmental activation in pts with CAD can be mapped, quantified and displayed in real time. The technique provides an alternative 3D measurement of stress induced ischemia.

Cor triatriatum is a rare congenital cardiac anomaly in which a common pulmonary venous chamber (proximal chamber) is separated from the left atrium (distal chamber) by a fibromuscular septum (membrane). Majority of the patients have one or more openings in the membrane. Cor triatriatum is usually an isolated congenital anomaly, but may be associated with cyanotic and acyanotic congenital heart diseases. The clinical manifestations depend on the size of the opening in the membrane. In most patients, the opening is severely restrictive and approximately 75 % of patients with Cor triatriatum die in infancy. In this case, we report for the first time, the use of Live 3 D echocardiography in the diagnosis of Cor triatriatum in a 27 year old Hispanic male.