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3D evaluation of left ventricular function in heart valve disease

  • Real-time 3D echo: really the gold standard, presented by B Cosyns (Brussels, BE)  
  • Is 3D contrast echo of added value, presented by M J Monaghan (London, GB)  
  • New insight from 3D strain imaging, presented by G A Derumeaux (Bron Cedex, FR)  
  • Usefulness of 3D transoesophageal echo, presented by A Stefanidis (Athens, GR)

The topic is tremendously ambitious: the goal of 3D in heart valve disease moves beyond the valve evaluation and seeks for its importance in LV function evaluation!
The location of a full room of Euroecho is perfect; the speakers are great experts in their fields, very wise and balanced in presenting data.

The first talk from Bernard Cosyns underlines the importance of a precise 3D evaluation of LV in valvular disease: the accurate volume evaluation is fundamental for planning surgery in regurgitant valve disease; the LVOT measured in 2D is often a limitation for continuity equation for aortic stenosis and the LV mass needs to be evaluated in three-dimensional view to have the best prognostic predictive value.
Guidelines do not have 3D cut-off values yet, but with larger databases these 3D dimensions will be the best cut-off for surgery.

Is 3D contrast echo of added value? Mark Monaghan answers this intriguing question philosophically: “The law of physics are similar in 2D and 3D: If you have bad images with 2D you will have bad images in 3D!”. This is the basis for showing the importance of contrast to reduce variability and limitations in 3D assessment of LV volumes. In fact, the change in volume calculation obtained with contrast echo has been demonstrated to influence the indication for several cardiac invasive procedures and also for valve surgery in a small but important percentage of patients.

Prof Genevieve Derumeaux shows brilliantly a New insight from 3D strain imaging, going back to physiology and experimental studies. She points out the fact that a 3D increase of radial function acts initially to compensate for a reduction in longitudinal function. This effect has to be taken into account when evaluating patients with valvular heart disease and volume overload. She underlines that, besides strain, wall stress and elasticity also influence the contractility of left ventricle. So take care of volume and geometry, which affect basal strain in valve diseases, using the longitudinal strain, which shows less variability than radial strain.
The last presentation presented by Dr Stefanadis focused on the usefulness and limitations of 3D transoesophageal echo (TOE). Beware not to foreshorten the left ventricular apex when calculating volumes with TOE: this lesson is still useful in the 3D world.

After these four presentations and an animated and cultured discussion, we can go home with the idea of evaluating in a three-dimensional way also the left ventricle in valvular heart disease.




3D evaluation of left ventricular function in heart valve disease

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.

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