Echocardiography has become an essential clinical tool in cardiology practice because it is routinely used to diagnose a multitude of disease processes. The forces driving the evolution of echocardiography over five decades are worldwide research efforts resulting in exponential advances in ultrasound, electronics and computer technology. The fruit of these efforts is three-dimensional echocardiography (3DE), which was initially based on tedious and time-consuming offline reconstructions from ECG and respiratory-gated acquisition, but since the last decade effortlessly achieved in real time using matrix array transducer technology.1 The article by Hare and colleagues published in the April issue of Heart2 focused on the impact that information on left ventricular (LV) volumes and ejection fraction (EF) obtained from 3DE images might have on clinical decision-making. The results of this interesting study highlight once again the clinical benefits of this exciting new technology to both individual patients and the healthcare system as a whole.

THE TURNING POINT

Gated acquisition using either non-sequential or sequential methods had numerous limitations and its use was mostly restricted to research centres. To overcome these shortcomings, in the early 1990s, real-time volumetric scanners, using a sparse array transducer with parallel processing, provided the first three-dimensional ultrasound images of the heart.3 Despite the relatively low spatial and temporal resolution, this technology allowed fast acquisition of pyramidal datasets, which were displayed as C-scans and two-dimensional orthogonal scan planes in a single breath-hold. This methodology was used to investigate mitral valve disease, LV function and mass and used during stress testing, and provided the basis for further development of smaller transthoracic, fully sampled, matrix array transducers with larger numbers of elements.

With the recent technological advances, these transthoracic matrix transducers were not only capable of two-dimensional and colour Doppler imaging but also provided simultaneous biplane imaging, together with higher spatial and temporal …