Role of real time three-dimensional echocardiography in heart failure.

The incidence and prevalence of heart failure (HF) are increasing with high morbidity and mortality rates. Echocardiography is a very useful diagnostic tool for the evaluation of HF patients. Real time three-dimensional echocardiography (RT3DE) was introduced in the last decade and has proved to provide an accurate assessment of ventricular volume, mass, and function. In addition, it provides a comprehensive evaluation of the valves. However, its application remained limited to research work in selected cases because of a suboptimal image quality. The recent advances in the transducer and computer software technology enhanced the use of RT3DE in clinical practice. The application of RT3DE adds much information that helps in the assessment of HF patients. RT3DE became the standard in the assessment of left ventricular (LV) volumes, function, and mass. RT3DE is a promising tool for testing LV dyssynchrony due to its accuracy and reproducibility comparable to magnetic resonance imaging. The application of RT3DE for stress and myocardial perfusion studies is encouraging due to its short image acquisition time, but still requires wide-scale studies. Through cropping of the RT3DE full-volume, the direct visualization of the heart valves (especially mitral valve) in a surgical view could be easily obtained. In the near future, one would expect RT3DE to become an integral part of the assessment of HF patients.