Three-dimensional stress echocardiography: the promise and limitations of volumetric imaging

Three-dimensional (3D) volumetric imaging has potential advantages in stress echocardiography, including the ability to provide an unlimited number of planes for analysis and more rapid acquisition than conventional two-dimensional (2D) imaging. This review focuses on the advantages and disadvantages of 3D volumetric imaging and the current and future role of the technique in stress echocardiography.

Three-dimensional volumetric imaging uniformly shortens the time required for acquisition of stress images. The success of imaging is high with pharmacologic stress but the feasibility is not established with exercise stress. The lower spatial and temporal resolution of 3D imaging and artifacts introduced by suboptimal subvolume integration are limitations of the current 3D technique. The ability to provide more planes for analysis has not been clearly shown to improve the accuracy of stress echocardiography. However, 3D imaging eliminates apical foreshortening, which is common with 2D imaging, and may improve detection of apical wall motion abnormalities.

In general, 3D imaging has shown rates of success and accuracy comparable to those of 2D imaging in pharmacologic stress echocardiography. Further studies are needed in larger and more heterogeneous patient populations. As improvements in 3D technology continue, successful application of the technique to exercise echocardiography is likely. Development of automated image registration, quantitative analysis techniques, and single beat acquisition is needed to fully exploit the potential of 3D imaging in the stress laboratory.