The Role of 2D and 3D Echo in Mitral Stenosis

Mitral stenosis is an important cause of heart valve disease globally. Echocardiography is the main imaging modality used to diagnose and assess the severity and hemodynamic consequences of mitral stenosis as well as valve morphology. Transthoracic echocardiography (TTE) is sufficient for the management of most patients. The focus of this review is the role of current two-dimensional (2D) and three-dimensional (3D) echocardiographic imaging for the evaluation of mitral stenosis.

Three-dimensional echocardiography in transcatheter edge-to-edge tricuspid valve repair

Background Transcatheter tricuspid valve repair (TTVR) is a new treatment option for severe tricuspid regurgitation (TR). First reports have reported conflicting results on development of right ventricular (RV) function after TTVR and questioned the role of conventional echocardiographic parameters to predict outcome. Purpose The aim of this study was to evaluate 3D echocardiography for the comprehensive assessment of RV function and its prognostic value for TTVR-treated patients. Methods We included patients undergoing TTVR from February 2017 to July 2019 who had preprocedural 3D assessment of RV volumes and ejection fraction. At follow-up (FU), 3D echo was performed to evaluate right ventricular reverse remodeling. All-cause mortality was assessed as clinical endpoint. Results 75 patients treated with TTVR for isolated, severe TR had 3D echo assessment. TTVR reduced TR from grade ≥3+ to ≤2+ in 83.1% of patients at discharge. 3D-RV end-diastolic volume (−46.3 ml, p<0.001), end-systolic volume (−22.0 ml, p=0.027) and 3D-RV ejection fraction (−4.7%, p<0.001) decreased at short-term FU at 1-month and remained stable at 6-month FU. An impaired preprocedural 3D-RVEF <44% conferred higher mortality risk (Figure), and was an independent predictor for 1-year mortality (hazard ratio 5.32, p=0.033) in multivariable analysis. Tricuspid annular systolic excursion (TAPSE) and RV fractional area change were not predictive for this endpoint. Importantly, the observed decrease of 3D-RVEF function after TTVR was not associated with outcome (p=0.22 for decrease of 3D-RVEF vs. no decrease of 3D-RVEF in Kaplan-Meier analysis). Instead, left ventricular stroke volume index increased by 9.2% from 26.0 to 28.4 ml/m2 (p<0.01) Conclusion TTVR leads to right ventricular reverse remodeling and decrease of RV systolic function after TTVR. Impaired preprocedural RV systolic function is associated with worse clinical outcome. In contrast, the observed decrease of RV systolic function after TTVR was not associated with outcome. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Klinikum der Universtität München Figure 1

Comparative Study between 3D Echocardiography Right Ventricular -Volumes and Functions- and Invasive RV Quantification in children with valvular pulmonary stenosis pre and post balloon Dilation

Aim and objectives The aim of this study was To correlate between 3D echocardiographic assessment of RV volumes and functions with invasive RV quantification by angiography in children with mainly valvular pulmonary stenosis undergoing balloon pulmonary valvuloplasty pre & post balloon dilation, to evaluate the immediate impact of relieving obstruction on RV volumes. Patients and Methods The study included 25 patients in the pediatric age group (up to 18 years old) with Pulmonary valve stenosis referred to our congenital and structural heart disease unit cardiology department in Ain shams university hospital for balloon pulmonary valvuloplasty. All patients were subjected to history taking, clinical examination and ECG recording. Then echocardiographic assessment by 2D and 3D was done to all patients pre and post BPV. All patients were subjected to have pre and post RV angiography for assessment of RV volumes and functions angiographically. Results The study included 25 patients,65% of patients were males and 44% were females, mean of age was 22.79 with range from 2 to 144 months There was statistically significant increase in 3D Echo RV quantification post BPV in comparison to 3D Echo RV quantification pre BPV with RV/EDV(p-value:0.001), RV/ESV(p-value:0.034), RV/SV(p-value:0.002), FAC %(p-value:0.014), TAPSE(p-value:0.001). Also,there was statistically significant increase in angiographic RV quantification post BPV in comparison to angiographic RV quantification pre BPV with EDV(p-value:<0.001), ESV(p-value:<0.001), SV(pvalue:<0.001) and EF %(p-value:<0.001). Conclusion 3DE RV volumes and function shows good correlation and agreement with invasive RV quantification by angiography in children with valvular pulmonary stenosis undergoing balloon pulmonary valvuloplasty.

Systematic Comparison of Left Ventricular Geometry Between 3D-Echocardiography and Cardiac Magnetic Resonance Imaging

Aims: Left ventricular (LV) volumes estimated using three-dimensional echocardiography (3D-echo) have been reported to be smaller than those measured using cardiac magnetic resonance (CMR) imaging, but the underlying causes are not well-understood. We investigated differences in regional LV anatomy derived from these modalities and related subsequent findings to image characteristics.Methods and Results: Seventy participants (18 patients and 52 healthy participants) were imaged with 3D-echo and CMR (<1 h apart). Three-dimensional left ventricular models were constructed at end-diastole (ED) and end-systole (ES) from both modalities using previously validated software, enabling the fusion of CMR with 3D-echo by rigid registration. Regional differences were evaluated as mean surface distances for each of the 17 American Heart Association segments, and by comparing contours superimposed on images from each modality. In comparison to CMR-derived models, 3D-echo models underestimated LV end-diastolic volume (EDV) by −16 ± 22, −1 ± 25, and −18 ± 24 ml across three independent analysis methods. Average surface distance errors were largest in the basal-anterolateral segment (11–15 mm) and smallest in the mid-inferoseptal segment (6 mm). Larger errors were associated with signal dropout in anterior regions and the appearance of trabeculae at the lateral wall.Conclusions: Fusion of CMR and 3D-echo provides insight into the causes of volume underestimation by 3D-echo. Systematic signal dropout and differences in appearances of trabeculae lead to discrepancies in the delineation of LV geometry at anterior and lateral regions. A better understanding of error sources across modalities may improve correlation of clinical indices between 3D-echo and CMR.

The association of 6-minute walking distance and real-time three-dimensional echocardiography in pulmonary hypertension

Background: The aim of this study was to evaluate the potential effect of 6-minute walking distance (6MWD) on exercise tolerance in patients with pulmonary hypertension (PH). To clarify whether 6WMD and right ventricle (RV) function measured by three-dimensional echocardiography (3D-echo) could result in better correlation with exercise capacity. Methods: 72 consecutive patients underwent right heart catheterization (RHC) and diagnosed with PH. Associations between 6WMD and measures of RV function were evaluated using the Pearson correlation coefficient. Receiver operating characteristic (ROC) curve analysis was applied to evaluate the clinical prognosis of patients. Results: RHC-derived parameters were significantly correlated with 6MWD: (RPVR = -0.719, RPAPs = -0.501, RPAPd = -0.404, and RPAPm = -0.468, all P <0.001). Meanwhile, 6MWD was positively correlated with CO (R = 0.54, P <0.001). Good correlations between 6MWD with 3D-echo parameters were shown as follows: R3D-RVEDV = -0.584, R3D-RVESV = -0.598, R3D-RVEF = 0.554, R3D-RV mass = -0.507, all P <0.001. The predictive value from 6MWD was not much inferior to the predictive values of PVR (AUC6MWD = 0.779 vs. AUCPVR = 0.875, both P <0.0001). Conclusions: 6MWD has a significant correlation with hemodynamic parameters obtained by RHC. And RV function obtained by 3D-echo result in better correlation with exercise capacity. 3D-echo might be candidate for RHC to assess right heart function in patients with PH.

Ultrafast high-resolution multi-parametric brain MRI using 3D Echo Planar Time-resolved Imaging

Multi-parametric quantitative MRI has shown great potential to improve the sensitivity and specificity of clinical diagnosis, but suffers from impractical scan time especially at high spatial resolution, a major limiting factor that prevents it from common use. To address this long-standing challenge, we introduce a novel approach, termed 3D Echo Planar Time-resolved Imaging (3D-EPTI), which significantly increases the acceleration capacity of MRI sampling, and provides unprecedented acquisition efficiency for multi-parametric MRI. The high acceleration capability in 3D-EPTI is achieved by exploiting the spatiotemporal correlation of MRI data at multiple timescales through new encoding strategies within and between its efficient continuous data readouts. This has enabled robust and repeatable whole-brain multi-parametric mapping at high isotropic resolution within minutes. 3D-EPTI may greatly facilitate the clinical adoption of quantitative MRI and push towards the next-generation of brain examination with high efficacy and accuracy for improved diagnosis and longitudinal monitoring. Moreover, 3D-EPTI also offers a powerful tool for fast and repeatable submillimeter multi-parametric imaging that can be used to study detailed brain intra-cortical architectures for neuroscientific research.

Localization of right ventricular non-apical lead position: comparison of three-dimensional echocardiography, computed tomography, and fluoroscopic imaging

Objective Right ventricular (RV) septal pacing is considered a better pacing procedure compared with traditional apical pacing. This study aimed to investigate agreement among computed tomography (CT), three-dimensional echocardiography (3D-echo), and fluoroscopy for evaluating the tip of the RV pacing lead in the non-apical position in patients with permanent pacemaker implantation. Methods Fifty-four patients were prospectively enrolled. Data on patients’ characteristics and imaging findings were analyzed. The agreement rate in distinguishing the RV septal lead position among the three imaging modalities was determined. Results Thirty-three (61%) patients were men and the median age was 76 years. Overall, the agreement rate among the three imaging modalities was 87% (47/54; Kappa ratio: 0.734). The agreement of 3D-echo compared with thoracic CT (Kappa ratio: 0.893) was better than that for thoracic CT and fluoroscopy (Kappa ratio: 0.658). Agreement between fluoroscopy and 3D-echo was lowest (Kappa ratio: 0.632). Conclusions Agreement in evaluating the position of the septal lead between thoracic CT and 3D-echo is better than that between other imaging modalities. Our findings indicate that 3D-echo imaging might be the best imaging tool for defining the tip of the RV non-apical lead position and be useful for guiding positioning of the RV lead.