Real-time three-dimensional echocardiography: still a research tool or an imaging technique ready for daily routine practice? A pilot feasibility study in a tertiary cardiology centre.

BACKGROUND

The majority of studies demonstrating the diagnostic potential of three-dimensional (3D) echocardiography have been conducted on selected series of patients in research laboratories.

AIM: To investigate the feasibility and usefulness of real-time 3D transthoracic echocardiography (RT 3D TTE) in daily routine practice.

METHODS

The study group consisted of 35 consecutive patients referred to our echocardiographic laboratory. All subjects underwent standard 2D TTE and RT 3D TTE with the use of a commercially available ultrasound system (Sonos 7500, Philips Medical Systems). The quality of 3D acquisitions and post-processed images was graded as: insufficient, satisfactory, good or demo.

RESULTS

3D TTE of the study group yielded 298 acquisitions. 87,2% of acquisitions required post-processing. The quality of 3D datasets was graded as insufficient in 8,0%, satisfactory in 31,4%, good in 37,2% and demo in 23,4% of all acquisitions and reconstructions. Mean time required for 3D TTE, including post-processing, was 12 minutes. 3D reconstructions were particularly helpful in patients with valvular disease or prostheses (n=13), enabling detailed qualitative analysis of leaflets morphology and mobility. In cases of mitral valve prolapse (n=4) 3D TTE allowed identification of the prolapsing scallops. 3D color Doppler flow mapping enabled complete visualization of the regurgitant jets. "En face" reconstructions of atrial septal defects (n=2) facilitated assessment of the morphology of the defects and the tissue rims. In patients with cardiac pacemaker (n=4) 3D TTE allowed excellent visualization of the ventricular lead along with its tip. In patients with ischemic heart disease (n=14) 3D TTE failed to provide additional, clinically relevant information.

CONCLUSIONS

RT 3D TTE may be used in clinical settings with high feasibility rate and provides additional, clinically relevant qualitative information. The lack of on-board quantitative analysis tools is the main limitation of the currently available system.