Three-Dimensional Stress Testing: Volumetric Acquisitions

Two-dimensional stress echocardiography is an established technique for detecting the presence and severity of coronary artery disease. It also provides myocardial viability data, prognostic information, and risk stratification before major cardiovascular and noncardiac surgery. The current limitation of two-dimensional stress echocardiography includes the difficulty in obtaining the same imaging plane at rest and during stress, which may result in over- or underestimation of wall motion assessment, particularly in patients who have resting wall motion abnormalities. The accurate assessment of the extent and severity of stress-induced wall motion abnormalities is often difficult, and wall motion abnormalities may be missed by visual inspection of wall motion from the standard two-dimensional views. Recent technological development and engineering refinements have allowed the application of real-time three-dimensional (RT3D) echocardiography in the routine clinical setting. Because full-volume datasets obtained with RT3D echocardiography incorporate information on the entire left ventricle in four volumetric datasets, RT3D stress echocardiography has the potential to overcome many of the limitations encountered with two-dimensional stress echocardiography. Two different types of imaging modes, full-volume and multiplane mode, can be used to acquire and analyze stress echocardiography. Both modes have their particular benefits and limitations. This article reviews the literature describing the clinical utility of RT3D stress echocardiography, with particular emphasis on full-volume datasets.