Transcript Document

Three-dimensional
echocardiography in the
clinical world
Prof. JL Zamorano
Director CV institute
University Clinic SC, Madrid
Advantages of 3D.
... additional advantages ?.
A
B
How do you prefer to see a mitral prolapse?
Your preference
A
B
Modes of 3D-Echocardiography.
Full volume.
Cropping: every orientation of the planes is possible
Advantages of 3D.
Spatial manipulation.
Optimal alineation of structures.
Views and planes impossible to get in 2D.
Single acquisition, multiple
information.
Easy approach to complex
problems.
Volumes calculation.
No geometrical assumption (Right
ventricle).
Precision  MRI, (but faster and cheaper).
J Am Coll Cardiol 2004;43: 2091–6
Evaluation of Mitral valve area
MVA estimated by:

1.5
1.0
2D Echo :


PHT
Planimetry
+1.96 SD
0.5
Gorlin - RT3D

0.60
Mean
0.0
0.08
-1.96 SD
-0.5

-0.44
PISA
-1.0



3D
Gorlin
-1.5
0.0
0.5
1.0
1.5
AVERAGE of Gorlin and RT3D
Conclusions:

3D RT is very accurate in assessing MVA

3D RT showed better agreement.
2.0
2.5
MV pre – post MVP
Conclusion: 3D RT better correlation with
Gorlin, after MVP
Mitral Valve.
Mitral stenosis.
Mitral valve.
Mitral stenosis.
3D: Best diagnostic
tool for structural
mitral evaluation.
Anatomy of leaflets, comissures,
subvalvular apparatus.
Planimetry of oriffice: superior to 2D.
Guide for balloon valvulotomy.
Score.
Oriffice post-valvuloplastia.
Complications.
Mitral valve.
Mitral regurgitation.
Circulation, March 2003
Mechanism of
Mi regurgitation
Mitral valve.
Mitral regurgitation.
Volumes quantification.
3D colour doppler quantification:
promising perspectives.
Mechanism of Mi regurgitation.
Lateral MR jets.

Real Time 3D. New perspective
3D MVP.

3D Protocol: 4 steps

1) P short axis + cutting planes
A3
A2
A1
P3
P2
P1
3D MV Prolapse

3D Protocol: 4 steps




1) P Shurt axis guided cutting planes
2) Apical + guided planes
3) Full volume
4) 3D color. MI.
Agreement 3D vs TEE

A3 k = 0.821
A2 k = 0.820
A1 k = 0.858
1.- 100% P2
2.- False negative (anterolateral region)
3.- False positive (inferomedial region)
P3 k = 0.934
P2 k = 1
P2
A1-P1
A3-P3
P1 k = 0.876
p< 0,0001
Volumes. 2D echo ??

2D:

Simpson
Problems:


¿Optimal alignement ?
Geometric asumptions
3D: Volumes calculation
Quantification of left ventricular volumes and ejection fraction
using freehand transthoracic three-dimensional echocardiography:
comparison with magnetic resonance imaging.
Mannaerts HF, Van Der Heide JA, Kamp O, Papavassiliu T, Marcus JT, Beek A, Van
Rossum AC, Twisk J, Visser CA.
JASE 2003
3D
underestimates
volumes
3D. Volumes


2D: Simpson biplane
3D (FV):




2 planes
4 planes
8 planes
CMR: Simpson
RT3D: Semiautomated border detection
Improved semiautomated quantification of LV volumes and EF
using 3D echocardiography with a full matrix-array transducer:
comparison with magnetic resonance imaging.
Caiani EG, Corsi C, Zamorano JL, Sugeng L, MacEneaney P, Weinert L, Battani R,
Gutiérrez-Chico JL, Koch R, Pérez de Isla L, Mor-Avi V, Lang RM. JASE 2005 Aug
Volúmenes 3D
Volumes calculation – Slice view
Direct comparison with gold standard
Aortic area with RT 3D echo ?
Aortic stenosis: Continuity equation
Cumulative error in several parameters
Depending on good parasternal & apical
acoustic windows
TSVI
IVT TSVI
AAo = π
D
IVT
2
TSVI
TSVI
(
)
2
IVTAo
Aortic stenosis: Continuity equation
Cumulative error in several parameters
Depending on good parasternal & apical
acoustic windows
TSVI
IVT TSVI
AAo = π ( D
TSVI
2
)2 IVT
TSVI
IVTAo
STROKE VOLUME
Aortic stenosis: Continuity equation
Cumulative error in several parameters
Depending on good parasternal & apical
acoustic windows
TSVI
IVT TSVI
AAo =
SV
IVTAo
STROKE VOLUME
Aortic area: RT3D-Doppler hybrid approach
Aortic area:
Invasive:
Gorlin
Hakki
Echo:
Continuity equation
Volumetric Simpson
RT 3D
Aortic area with RT3D: Results
Correlation (linear association):
Absolute agreement:
Pearson r
ICCa (Intraclass correlation coefficient – absolute)
Lin’s coefficient
Limitations of 3D.
Quantification off-line ??.
Time-consuming.
Full-volume mode: breathhold.
Image definition does not
improve respect to 2D.
Lower frame-rate.
Conclusions
3D is the best imaging for Mitral valve.
New approach to mitral anatomy and mitral
prolapse.
3D planimetry: Best non-invasive methode for Mi
stenosis.
Mechanism of Mi regurgitation.
Best option for complex problems, MVP, surgical
repair.
3D colour Doppler: promising perspectives for
quantification of valvular regurgitations.
Volume estimation… similar to MRI
3 is the number !
Exécutif
Législatif
Judiciaire
3D
!!!