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3D in assessing Cardiac Chambers

Session 607

It was my pleasure to co-chair this excellent session with Professor Luigi Badano from Padua. Prof Badano is a world-renowned expert on 3D Echo and we were both impressed by the quality of the presentations.

We started the session with a talk from Dr Karina Addetia from Chicago who covered why we need 3D for assessing the LV. She explained the limitations of conventional methods of LV evaluation, from the “eyeball” technique right through to bi-plane Simpson’s, which is susceptible to foreshortening and lack of accuracy in distorted ventricles. Dr Addetia explained very clearly why the current EACVI and ASE guidelines recommend the use of 3D where it is feasible and where the necessary expertise exists. She also demonstrated why 3D can give us new information on LV shape and apical curvature, both of which appear to be prognostically important.

We moved across to the right ventricle with the next presentation from Dr Nozami Watanabe from Japan. The right ventricle has a complex shape and it is very easy to undersize it with 2D Echo. She explained how dedicated 3D analysis software could help overcome this. In addition, evaluation of the tricuspid valve annulus appears important and can be achieved using 3D techniques. The take home message was that 3D RV assessment, whilst being more accurate than 2D, should be used in combination with other parameters of RV function.

The last presentation in this session addressed the remaining two cardiac chambers and Prof Victor Mor-Avi elegantly covered the role of 3D Echo in assessing the left and right atria. He started by explaining why measurement of LA size is so important for prognosis, predicting cardiac events and assessing diastolic function. It was clear from the data presented by Prof Mor-Avi than 3D LA volumes are so much better than linear dimensions or LA areas in predicting outcomes. He then went on to explain that the conventional methods of measuring LA volumes (area-length and bi-plane Simpson’s) are very limited and potentially inaccurate. 3D Echo assessment of volumes correlate much better with CMR than the older, more traditional methods, and have led to a change in normal values contained in the Guidelines. 3D also gives us the possibility of looking at the dynamic function of the LA and also measuring 3D LA strain. The latter parameter is proving very useful in terms of predicting the development of AF in selected patient groups. Prof Mor-Avi concluded his talk by explaining that the same principles apply to the right atrium, although less data currently exists.

This was one of the first sessions of EuroEcho 2015 and will, I’m sure, prove to be one of the most successful. The overall theme was why we need 3D Echo and I’m sure that none of audience were left in any doubt of the vital role this technique will continue to play in the assessment of all the cardiac chambers.

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.