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Left ventricular assessment using real time three dimensional echocardiography
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  1. L Sugeng,
  2. L Weinert,
  3. R M Lang
  1. Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
  1. Correspondence to:
    Roberto M Lang, MD, University of Chicago, MC 5084, 5841 S. Maryland Avenue, Chicago, IL 60637, USA;
    rlangmedicine.bsd.uchicago.edu

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The ability to accurately assess left ventricular function non-invasively is essential for patient management since it has been known for years that left ventricular ejection fraction serves as an important predictor of long term survival. Although two dimensional (2D) echocardiography is routinely used in clinical practice to obtain information on left ventricular dimension, wall thickness, and function, this technique is limited because it relies heavily on geometrical assumptions to provide quantitative parameters of left ventricular function. In order to avoid these geometrical constraints, three dimensional (3D) reconstructions of the left ventricular cavity have been performed over the last 30 years using a variety of method.

Although multiple studies have validated the superiority of 3D over 2D echocardiography to assess left ventricular function, 3D methods have not been embraced in clinical practice because of the cumbersome methodology used to date for both data acquisition and analysis. This manuscript will review prior 3D techniques used to quantitate left ventricular function and present an overview of the recently introduced matrix array transducer capable of generating real-time 3D transthoracic echocardiographic images.

3D ECHOCARDIOGRAPHIC METHODS

Estimations of left ventricular volumes were first performed using M mode echocardiography. Published data using this unidimensional technique reported a large volume discrepancy between this methodology and angiographic data. Although 2D echocardiography has improved left ventricular volume calculations, underestimations are still frequently reported when compared with gold standard methods such as angiography and magnetic resonance imaging (MRI).1–4

Three separate steps are required to assess left ventricular function using 3D echocardiography: (1) data acquisition, (2) image processing, and (3) data analysis. Acquisition of a 3D volume dataset may be obtained with a variety of methods such as free-hand scanning using mechanical or non-mechanical locators, gated sequential acquisition methods, and sparse and full matrix array transducers capable of obtaining real time data sets. …

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