Head to head comparison of 2D vs real time 3D dipyridamole stress echocardiography
Real-time three-dimensional (RT-3D) echocardiography has entered the clinical practice but true incremental value over standard two-dimensional echocardiography (2D) remains uncertain in stress echo. The aim of the present study is to establish the additional value of RT-3D stress echo over standard 2D stress echocardiography.
We evaluated 23 consecutive patients (age = 6510 years, 16 men) referred for dipyridamole stress echocardiography with Sonos 7500 (Philips Medical Systems, Palo, Alto, CA ) equipped with a phased - array 1.6-2.5 MHz probe with second harmonic capability for 2D imaging and a 2-4 MHz matrix-phased array transducer producing 60 x 70 volumetric pyramidal data containing the entire left ventricle for RT-3D imaging. In all patients, images were digitally stored in 2D and 3D for baseline and peak stress with a delay between acquisitions of less than 60 seconds.
Wall motion analysis were interpreted on-line for 2D and off-line for RT-3D by joint reading of two observers. Segmental image quality was scored from 1=excellent to 5=uninterpretable.
Interpretable images were obtained in all patients. Acquisition time for 2D images was 67 21 sec while it was 40 22 sec for RT-3D (p=0.5).
Wall motion analysis time was 0.67 21 min for 2D and 13 7 min for 3D (p=0.0001). Segmental image quality score was 1.4 0.5 for 2D and 2.6 0.7 for 3D (p=0.0001).
Positive ischemic exams were found in 5/23 patients. 2D and RT-3D agreed in three of these five positive exams while they both independently score a positive exam.
Overall stress result (positive vs negative) concordance was 91 % (Kappa=0.80) between 2D and RT-3D. During dipyridamole stress echocardiography RT-3D imaging is highly feasible and shows high concordance with standard 2D stress echo.
2D images take longer to acquire and RT-3D more time-consuming to analyze. At present, there is no clear clinical advantage justifying routine RT-3D stress echocardiography.
Author: Silvia Varnero, Patricia Santagata, Lorenza Pratali, Massimiliano Basso, Alfredo Gandolfo and Paolo Bellotti
Credits/Source: Cardiovascular Ultrasound 2008, 6:31
Published on: 2008-06-20
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