J Cardiovasc Ultrasound.  2014 Jun;22(2):49-57. 10.4250/jcu.2014.22.2.49.

Current Status of 3-Dimensional Speckle Tracking Echocardiography: A Review from Our Experiences

• Seo Y
• Ishizu T
• Aonuma K

• KMID: 2177459
• DOI: http://doi.org/10.4250/jcu.2014.22.2.49

Abstract

Cardiac function analysis is the main focus of echocardiography. Left ventricular ejection fraction (LVEF) has been the clinical standard, however, LVEF is not enough to investigate myocardial function. For the last decade, speckle tracking echocardiography (STE) has been the novel clinical tool for regional and global myocardial function analysis. However, 2-dimensional imaging methods have limitations in assessing 3-dimensional (3D) cardiac motion. In contrast, 3D echocardiography also has been widely used, in particular, to measure LV volume measurements and assess valvular diseases. Joining the technology bandwagon, 3D-STE was introduced in 2008. Experimental studies and clinical investigations revealed the reliability and feasibility of 3D-STE-derived data. In addition, 3D-STE provides a novel deformation parameter, area change ratio, which have the potential for more accurate assessment of overall and regional myocardial function. In this review, we introduced the features of the methodology, validation, and clinical application of 3D-STE based on our experiences for 7 years.

Keyword

Three-dimensional echocardiography; Speckle tracking; Cardiac function

MeSH Terms

Echocardiography*
Echocardiography, Three-Dimensional
Stroke Volume

Figure

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  Fig. 1 Speckle tracking with cubic template. The 3-dimensional speckle tracking method of the volume of interest (white line cubic template) from one volume (baseline volume) to the next volume (red line cubic template).

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  Fig. 2 Parametric images of multiplanar reconstruction (MPR) and strain-time curves. On MPR images (upper panel), radial (red arrow), circumferential (white arrow), and longitudinal strain (blue arrow) are shown. Under panels show each strain-time curve.

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  Fig. 3 3D-strain. The figures show deformation including shear strain. L0 means a baseline length between endo- and epicardium. Radial strain is calculated as (Lr - L0) / L0. If the shear (α degree) is caused between radial and longitudinal direction, the shear (β degree) is caused between radial and circumferential direction, and without shear between circumferential and longitudinal direction, the length between estimated endo- and epicardial points at end-systole is L. The novel parameter 3D-strain is calculated as (L - L0) / L0, then, 3D-strain is greater than 3D-radial strain because L is longer than Lr.

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  Fig. 4 Area change ratio. The mid and right panels are the endocardial surface at end-diastole and systole, respectively. An area A0 is relocated and deformed to an area A1 by various wall motions including apical translation, regional rotation that causes shear strain, and longitudinal and circumferential contractions. The area change ratio is calculated as (A1 - A0) / A0.

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  Fig. 5 The relation between strain by sonomicrometry and 3-dimensional speckle tracking echocardiography (3D-STE). CS: circumferential strain, RS: radial strain, LS: longitudinal strain.

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  Fig. 6 The relation between area change ratio by sonomicrometry and 3-dimensional speckle tracking echocardiography. A: Scatter plot showing the relation between all measurements of area tracking by sonomicrometry and 3-dimensional speckle tracking echocardiography (3D-STE). The solid line shows a regression line of all measurements. The dashed dotted line shows a regression line at apex area (○). The dashed line shows a regression line at mid area (▴). B: Scheme of implanted positions of sonomicrometry crystals. Red and blue dots show each crystal position, and the blue area is a region area of mid anterior wall, and the yellow one is a region of apical one.

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  Fig. 7 Comparisons of area change ratio, circumferential strain, and longitudinal strain during baseline (Base), propranolol infusion (Prop), dobutamine infusion (Dob), and acute ischemia (Isc). Upper panels are corresponding to total data (Total), mid ones to mid anterior wall (Mid), and bottom ones to apical anterior wall (Apex). Area change ratio clearly distinguished changes in myocardial function induced by pharmacological stress and acute ischemia in both mid and apical anterior wall. *p < 0.001 vs. others.

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  Fig. 8 Out of plane phenomenon. Upper panels are 4 chamber and 2 chamber views at end-diastole and systole in a healthy subject. The color shows degree of longitudinal displacements during systole. White discs at end-diastole are moved to red discs level at end-systole, which distance is about 15 mm (red arrows). Lower panels show the 2-dimensional speckle tracking echocardiography (2D-STE) images at yellow dash arrow level. Since the white disc level is moved to apex at end-systole, the 2D-STE image at end-systole is changed to another plane of a basal level at end-diastole. Such changing of the plane of interest through a cardiac cycle is called as out of plane phenomenon.

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  Fig. 9 The affects of longitudinal displacements for the 2D- and 3D-circumferential strain (CS). Panel A shows the correlation between longitudinal displacement and the absolute differences between 2D- and 3D-CS. Panel B shows left ventricular segmental comparisons of longitudinal displacements between control (blue dots) and DCM (red dots). DCM: idiopathic dilated cardiomyopathy, LVEF: left ventricular ejection fraction.

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  Fig. 10 Regional wall motion abnormalities with 3-dimensional speckle tracking echocardiography. These images were obtained at experimental studies. Upper panels show plastic bag images and lower ones show polar map images at end-systole showing longitudinal strain (left panel), circumferential strain (central panel), and radial strain (right panel) during a coronary artery occlusion study. The blue area in the apex in each panel corresponds to dyskinetic motion induced by coronary artery occlusion.

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  Fig. 11 Comparisons of activation propagation in left bundle branch block. Left figures show activation images by 3-dimensional speckle tracking echocardiography (3D-STE) and right ones show propagation images by Ensite voltage mapping system in each panel from A to F. Panels A to C show the images from septum, and blue areas in the 3D-STE are the earliest contraction sites. White areas in the Ensite images are the electrical activation area. Panels D to F show the images from free wall, and yellow or orange areas are the latest contraction sites. Note the U shape propagation with functional block area in anterior wall.

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  Fig. 12 Right ventricular 3-dimensional speckle tracking echocardi-ography (3D-STE) images. Panels A to E show right ventricular (RV) multiplanar reconstruction images in a healthy subject; short axis view of apex (C), mid (D), base (E), apical 4 chamber view (A) and its orthogonal view (B). 3D-STE images using mesh imaging, and time area change ratio curves also are shown. The lower left panel shows the RV-STE at end-diastole, the center panel at mid-systole, and the right panel at end-systole.

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