Real-Time Three-Dimensional Echocardiography: Characterization of Cardiac Anatomy and Function—Current Clinical Applications and Literature Review Update

Abstract

Our review of real-time three-dimensional echocardiography (RT3DE) discusses the diagnostic utility of RT3DE and provides a comparison with two-dimensional echocardiography (2DE) in clinical cardiology. A Pubmed literature search on RT3DE was performed using the following key words: transthoracic, two-dimensional, three-dimensional, real-time, and left ventricular (LV) function. Articles included perspective clinical studies and meta-analyses in the English language, and focused on the role of RT3DE in human subjects. Application of RT3DE includes analysis of the pericardium, right ventricular (RV) and LV cavities, wall motion, valvular disease, great vessels, congenital anomalies, and traumatic injury, such as myocardial contusion. RT3DE, through a transthoracic echocardiography (TTE), allows for increasingly accurate volume and valve motion assessment, estimated LV ejection fraction, and volume measurements. Chamber motion and LV mass approximation have been more accurately evaluated by RT3DE by improved inclusion of the third dimension and quantification of volumetric movement. Moreover, RT3DE was shown to have no statistical significance when comparing the ejection fractions of RT3DE to cardiac magnetic resonance (CMR). Analysis of RT3DE data sets of the LV endocardial exterior allows for the volume to be directly quantified for specific phases of the cardiac cycle, ranging from end systole to end diastole, eliminating error from wall motion abnormalities and asymmetrical left ventricles. RT3DE through TTE measures cardiac function with superior diagnostic accuracy in predicting LV mass, systolic function, along with LV and RV volume when compared with 2DE with comparable results to CMR.

Normal reference values of three‐dimensional speckle‐tracking echocardiography‐derived mitral annular dimensions and functional properties in healthy adults: Insights from the MAGYAR‐Healthy Study

“…Although knowledge of the normal ranges of MA dimensions would be essential in the clinical practice, they were provided so far by a limited number of echocardiographic studies 11,12 . Three‐dimensional echocardiography opens new opportunities in assessing valves due to its potential for “en‐face” measurements 1,2,16 . However, two different 3D echocardiographic techniques can be used in clinical practice: the volumetric real‐time 3D echocardiography (RT3DE), widely available since 2003, 17 and 3DSTE, which encompasses benefits of 3D echocardiography and STE 1,2 .…”

Usefulness of three-dimensional echocardiography for assessment of left and right ventricular volumes in children, verified by cardiac magnetic resonance. Can we overcome the discrepancy?

“…Accurate and regular assessment of ventricular volumes in children is crucial for diagnosis, risk stratification, predicting long-term outcome, and decision making in patients with heart defects, cardiomyopathies, and arrhythmias. Three-dimensional echocardiography (3D-ECHO) is already widely embraced in adult cardiology, and many studies have addressed its use in children [3,4,[10][11][12]. However, although ventricular function assessment is highly praised in the literature, the accuracy of volumetric analysis inspires much less enthusiasm, especially in the paediatric population.…”

“…Published studies were able to prove three-dimensional echocardiography (3D-ECHO) to be an accessible, easy, and inexpensive tool for the assessment of cardiac morphology in everyday clinical practice [ 3 , 4 ]. It combines accuracy close to CMR with the accessibility and cost effectiveness of 2D-ECHO.…”

Usefulness of three-dimensional echocardiography for the assessment of ventricular function in children: Comparison with cardiac magnetic resonance, with a focus on patients with arrhythmia

“…Three-dimensional echocardiography, with its rapid evolution during the last three decades, seems to be an accessible and inexpensive tool for the assessment of cardiac function in clinical practice because it combines the accuracy of magnetic resonance imaging with the already high and constantly expanding accessibility and cost effectiveness of two-dimensional ultrasound systems [18][19][20][21][22]. The image acquisition is faster than CMR and requires fewer consecutive regular heart beats to produce data of adequate quality.…”