Wesley Lim

Introduction. Heart failure is a progressive disease that is often diagnosed via 2D echocardiography techniques. 2D speckle tracking methods have allowed for calculation of key heart failure metrics such as ejection fraction and myocardial strain.^1,2 However, 3D speckle tracking echocardiography (3DSTE) is an emerging technique that touts improved accuracy in calculating myocardial deformation.^3,4 In addition, it has been shown to be more effective in detecting early stage heart failure, especially in cases of subclinical dysfunction.⁵ Methods. Patients with aortic valvular disease were recruited and underwent conventional 2D echocardiography as well as 3DSTE. Strain measured via both techniques were compared. Results. Strain identified via 3DSTE were indicative of early stages of heart failure in these patients.⁴ 3DSTE benefits over 2D methods due to a shorter analysis time and freedom from geometric assumptions. Discussion/Conclusion. 2DSTE is a useful tool in calculating cardiac function, but is limited by assumptions of myofibril shape along a single axis.⁶ 3DSTE improves upon the 2D modality by calculating area strain, which can factor in the myocardial deformation both circumferentially and longitudinally. It offers an improvement in terms of accuracy and reproducibility and does not make any geometric assumptions of myofibril shape and direction.⁴ However, it is limited by requiring a higher temporal resolution in order to capture the acoustic speckles. Ultimately, 3DSTE is more sensitive for detecting subclinical levels of LV dysfunction.⁵ Myocardial deformation may occur in the early stages of LV failure, even if other common metrics such as LV ejection fraction may be within normal range. This suggest that 3DSTE may be an accurate for detection of early-stage LV failure.

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