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Updated: Jul 6, 2026
Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
Published on: October 28, 2020
Diagnostic value of left ventricular outflow area in patients with hypertrophic cardiomyopathy: a real-time
Shota Fukuda1, Harry M Lever, William J Stewart
1Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Insights
Real-time 3D echocardiography accurately measures left ventricular outflow tract area to diagnose obstruction in hypertrophic cardiomyopathy patients. This technique aids in assessing both resting and provoked obstruction, improving clinical management.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Real-time 3D echocardiography (3DE) can measure left ventricular outflow tract area (A(LVOT)).
- Clinical utility of 3DE-derived A(LVOT) in hypertrophic cardiomyopathy (HCM) remains unclear.
Purpose of the Study:
- Assess feasibility and accuracy of 3DE-derived A(LVOT) for diagnosing significant LVOT obstruction in HCM patients.
- Investigate the diagnostic performance of A(LVOT) in identifying resting and provoked obstruction.
Main Methods:
- 162 HCM patients underwent 3DE using a volumetric system.
- Systolic A(LVOT) measured by manipulating 2D planes in 3D space.
- LVOT pressure gradients assessed by Doppler; provocation used for non-obstructed patients.
Main Results:
- 142 patients analyzed after exclusions (poor image quality, system differences).
- A(LVOT) inversely correlated with LVOT pressure gradients (rest: r=0.82; post-provocation: r=0.60).
- A(LVOT) < 0.85 cm² predicted resting obstruction (87% sensitivity, 77% specificity); < 2.0 cm² predicted provoked obstruction (81% sensitivity, 90% specificity).
Conclusions:
- Real-time 3DE measurement of A(LVOT) is feasible and accurate.
- This method successfully diagnoses and quantifies LVOT obstruction in HCM patients.
- 3DE provides valuable assessment of both resting and provoked LVOT obstruction.
Background:
Earlier studies demonstrated the ability of real-time 3-dimensional (3D) echocardiography (3DE) to measure left ventricular outflow tract (LVOT) area (A(LVOT)) in patients with hypertrophic cardiomyopathy (HCM). However, its clinical value is unknown.
Objective:
We sought to investigate the feasibility and accuracy of real-time 3DE-derived A(LVOT) to diagnose significant LVOT obstruction in a large number of patients with HCM.
Methods:
A total of 162 patients with HCM had 3DE by using a volumetric system. The smallest A(LVOT) during systole was determined by moving a 2-dimensional plane in 3D space. The pressure gradient across LVOT was assessed by continuous wave Doppler method. Provocation was performed in patients without significant LVOT obstruction (pressure gradient across LVOT < 50 mm Hg) at rest.
Results:
Twenty (12%) patients with poor image quality of 3DE were excluded; 16 (28%) patients with a volumetric system, but only 4 (4%) patients with commercial equipment (P < .001). In the remaining 142 patients, A(LVOT) inversely correlated with pressure gradient across LVOT both at rest (r = 0.82, P < .001) and after provocation (r = 0.60, P < .001). The value of A(LVOT) less than 0.85 cm(2) and less than 2.0 cm(2) predicted resting and provokable LVOT obstruction with sensitivity of 87% and 81%, and specificity of 77% and 90%, respectively.
Conclusions:
Real-time 3DE measurement of A(LVOT) was successful in diagnosing and quantifying LVOT obstruction at rest and after provocation in a large number of patients with HCM.
