Assessment of left ventricular regional wall motion abnormalities using regional time-volume curves obtained by real time three-dimensional echocardiography

Background: Three-dimensional echocardiography provides a volumetric measurement of global and regional left ventricular (LV) function. It avoids the subjectivity of 2D echocardiography in the assessment of regional wall motion abnormalities (RWMA). Purpose: Evaluate the feasibility and practicality of 3D echocardiography in the evaluation of ischemic patients with abnormal regional LV contractility. Methods: The study included 40 patients with ischemic heart disease and RWMA as well as 30 control subjects. They underwent routine clinical examination and conventional 2D echocardiographic assessment. Segments were categorized as; normal, hypokinetic; akinetic or dyskinetic. Three-dimensional echocardiographic images were acquired and later on analyzed offline. Global LV function was semiautomatically calculated by the machine using volumetric measurements. Regional LV function was calculated manually for the 17 LV segments by detecting the end-diastolic (EDD) and end-systolic (ESD) points on the specific segment volume curve and the regional ejection fraction (EF) was calculated by the following formula {(EDDx-ESDx)/EDDx}, where x represents the specific segment. Regional EF was compared between patients and control subjects. Results: The mean age was 55.0 +/- 8.0 and 32.6 +/- 8.5 years (P < 0.001) in patients and control groups, respectively. No statistically significant difference in EF between 2D and 3D images (47.3 +/- 10.5 vs 48. 0 +/- 8.0, p = 0.6). There was a good correlation between the 2D-RWMA and 3D-regional EF, and this correlation was consistent in the whole 17 segments. Conclusion: Three-dimensional echocardiography is an easy, non-invasive and objective tool to detect regional wall motion abnormalities in ischemic patients. It shows comparable results with conventional 2D images with the advantage of quantitative assessment of regional myocardial function. (C) 2018 Egyptian Society of Cardiology. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license.