EAE/ASE Recommendations for Image Acquisition and Display Using Three-Dimensional Echocardiography

Abstract

Writing Committee of the American Society of Echocardiography. Drs. Lang and Badano contributed equally to this report. Writing Committee of the European Association of Echocardiography. Drs. Lang and Badano contributed equally to this report. Writing Committee of the American Society of Echocardiography. Writing Committee of the American Society of Echocardiography. Writing Committee of the European Association of Echocardiography. Writing Committee of the European Association of Echocardiography. Writing Committee of the European Association of Echocardiography. Writing Committee of the European Association of Echocardiography. Writing Committee of the American Society of Echocardiography. Writing Committee of the European Association of Echocardiography. Writing Committee of the European Association of Echocardiography. Writing Committee of the European Association of Echocardiography. Writing Committee of the European Association of Echocardiography. Writing Committee of the American Society of Echocardiography. Writing Committee of the American Society of Echocardiography. Writing Committee of the European Association of Echocardiography. Writing Committee of the European Association of Echocardiography. Writing Committee of the American Society of Echocardiography. Writing Committee of the American Society of Echocardiography. Writing Committee of the European Association of Echocardiography. Writing Committee of the American Society of Echocardiography. Writing Committee of the American Society of Echocardiography. Writing Committee of the American Society of Echocardiography. Writing Committee of the American Society of Echocardiography. Writing Committee of the European Association of Echocardiography. Writing Committee of the American Society of Echocardiography. Writing Committee of the European Association of Echocardiography. Writing Committee of the American Society of Echocardiography. Cardiac resynchronization therapy Electrocardiographic Left ventricular Right ventricular Systolic dyssynchrony index Transesophageal echocardiographic Three-dimensional Three-dimensional echocardiographic Transthoracic echocardiographic Tricuspid valve Two-dimensional Three-dimensional (3D) echocardiographic (3DE) imaging represents a major innovation in cardiovascular ultrasound. Advancements in computer and transducer technologies permit real-time 3DE acquisition and presentation of cardiac structures from any spatial point of view. The usefulness of 3D echocardiography has been demonstrated in (1) the evaluation of cardiac chamber volumes and mass, which avoids geometric assumptions; (2) the assessment of regional left ventricular (LV) wall motion and quantification of systolic dyssynchrony; (3) presentation of realistic views of heart valves; (4) volumetric evaluation of regurgitant lesions and shunts with 3DE color Doppler imaging; and (5) 3DE stress imaging. However, for 3D echocardiography to be implemented in routine clinical practice, a full understanding of its technical principles and a systematic approach to image acquisition and analysis are required. The main goal of this document is to provide a practical guide on how to acquire, analyze, and display the various cardiac structures using 3D echocardiography, as well as limitations of the technique. In addition, this document describes the current and potential clinical applications of 3D echocardiography along with their strengths and weaknesses. An important milestone in the history of real-time 3D echocardiography was reached shortly after the year 2000, with the development of fully sampled matrix-array transducers. These transducers provided excellent real-time imaging of the beating heart in three dimensions and required significant technological developments in both hardware and software, including transducer design, microelectronic techniques, and computing. Currently, 3DE matrix-array transducers are composed of nearly 3,000 piezoelectric elements with operating frequencies ranging from 2 to 4 MHz and from 5 to 7 MHz for transthoracic echocardiographic (TTE) and transesophageal echocardiographic (TEE) imaging, respectively. These piezoelectric elements are arranged in a matrix configuration within the transducer and require a large number of digital channels for these fully sampled elements to be connected. To reduce both power consumption and the size of the connecting cable, several miniaturized circuit boards are incorporated into the transducer, allowing partial beam-forming to be performed in the probe. Additionally, developments in transducer technology have resulted in a reduced transthoracic transducer footprint, improved side-lobe suppression, increased sensitivity and penetration, and the implementation of harmonic capabilities that can be used for both grayscale and contrast imaging. The most recent generation of matrix transducers are significantly smaller than the previous ones, and the quality of two-dimensional (2D) and 3D