Evaluation of Left Ventricular Structure and Function using 3D Echocardiography

Summary

In this article, we provide a step-by-step acquisition and analysis protocol for the volumetric assessment and speckle-tracking analysis of the left ventricle by 3D echocardiography, particularly focusing on practical aspects that maximize the feasibility of this technique.

Abstract

Three-dimensional (3D) quantification of the left ventricle (LV) provides significant added value in terms of diagnostic accuracy and precise risk stratification in various cardiac disorders. Recently, 3D echocardiography became available in routine cardiology practice; however, high-quality image acquisition and subsequent analysis have a steep learning curve. The present article aims to guide the reader through a detailed 3D protocol by presenting tips and tricks and also by highlighting the potential pitfalls to facilitate the widespread but technically sound use of this important technique concerning the LV. First and foremost, we show the acquisition of a high-quality 3D dataset with optimal spatial and temporal resolution. Then, we present the analytical steps toward a detailed quantification of the LV by using one of the most widely applied built-in software. We will quantify LV volumes, sphericity, mass and also systolic function by measuring ejection fraction and myocardial deformation (longitudinal and circumferential strain). We will discuss and provide clinical examples about the essential scenarios where the transition from a conventional echocardiographic approach to a 3D-based quantification is highly recommended.

Introduction

The assessment of left ventricular (LV) morphology and function is the predominant purpose of general and even more specific investigations in cardiology¹. The widely available and noninvasive transthoracic echocardiography (TTE), which can provide dense amounts of information, is the method of choice for a convenient, fast, and cost-effective evaluation.

Measurement of LV mass, volumes, and subsequent ejection fraction holds significant diagnostic and also prognostic value². The more accurate a given measure is, the higher its value will be. A better correlation with gold standard cardiac mag....

Protocol

This protocol follows the guidelines of the Semmelweis University Regional and Institutional Committee of Science and Research Ethics. The present protocol applies to a specific vendor. Although some steps remain valid regardless of the ultrasound machine and postprocessing software, important differences may exist if using other vendors' solutions.

1. Technical requirements

1. Utilize an echocardiography machine capable of 3D imaging.
2. Connect a 3D transthoracic echocardiography capable phased array transducer.
3. Apply the built-in 3-lead ECG of the ultrasound system to allow the system to synchronize the reco....

Results

3D analysis of the LV is feasible in the majority of patients. Case 1 is a healthy volunteer with normal ventricular volumes and function (Figure 1). Case 2 (Figure 2) is a 64-year old male patient with dilated cardiomyopathy and a wide QRS complex (160 ms) of left bundle branch block morphology. Gold standard CMR measurements were the following: end-diastolic volume: 243 mL, end-systolic volume: 160 mL, ejection fraction: 34%, L.......

Discussion

LV morphological and functional measurements represent cornerstones of diagnosis, management, and follow-up of cardiac diseases; moreover, they are powerful predictors of outcome. Generally, 2D echocardiography-based evaluation of the LV is recommended by current practice guidelines; however, 3D echocardiography has been proven to be more accurate as it is free from geometrical assumptions concerning LV shape^7,8. Deformation imaging by speckle tracking is a robus.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
3V-D/4V-D/4Vc-D	General Electric	n.a.	ultrasound probe
4D Auto LVQ	General Electric	n.a.	software for analysis
E9/E95	General Electric	n.a.	ultrasound machine
EchoPac v203	General Electric	n.a.	software for analysis