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Updated: Jun 17, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Long-term prognostic significance of three-dimensional echocardiographic parameters of the left ventricle and left
Stefano Caselli1, Emanuele Canali, Maria Laura Foschi
1Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy. stefano.caselli@uniroma1.it
Insights
Three-dimensional echocardiography offers superior prognostic insights compared to 2D methods. Key parameters like left atrial minimum volume from 3D echo are strong predictors of cardiovascular events in outpatients.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Echocardiography is crucial for assessing cardiac function and predicting cardiovascular events.
- Traditional two-dimensional echocardiography (2D echo) has limitations in accurately quantifying cardiac volumes and function.
- Three-dimensional echocardiography (3D echo) offers enhanced spatial resolution and volumetric assessment capabilities.
Purpose of the Study:
- To evaluate the long-term prognostic significance of 2D and 3D echocardiography in outpatients.
- To compare the predictive power of various echocardiographic parameters for major cardiovascular events.
Main Methods:
- One hundred seventy-eight outpatients underwent both 2D and 3D echocardiography for assessment of left ventricular (LV) and left atrial (LA) volumes, mass, and ejection fraction.
- Patients were followed for a median of 45 months for major adverse cardiovascular events (MACE), including death, myocardial infarction, and stroke.
- Statistical analysis, including multivariate analysis, was performed to determine the prognostic value of echocardiographic parameters.
Main Results:
- 31 patients (17%) experienced major cardiovascular events during follow-up.
- 2D echo parameters (LV end-systolic volume and mass) showed a significant relationship with cardiovascular events.
- 3D echo parameters, including LV volumes, mass, ejection fraction, and LA maximum and minimum volumes, were all significantly associated with cardiovascular events.
- 3D echo-derived LA minimum volume emerged as the strongest independent predictor of adverse cardiovascular events (HR: 1.217; P = 0.002).
Conclusions:
- 3D echocardiography provides more accurate and clinically relevant prognostic information compared to 2D echocardiography.
- LA minimum volume, as assessed by 3D echo, is a powerful independent predictor of long-term cardiovascular outcomes in outpatients.
- The enhanced accuracy of 3D echo supports its routine use for risk stratification in clinical practice.
Aims:
We sought to investigate the long-term prognostic significance of two- and three-dimensional echocardiography.
Methods And Results:
One hundred and seventy-eight consecutive outpatients underwent two-dimensional echocardiography and three-dimensional echocardiography for the assessment of LV volumes, mass, ejection fraction, and LA maximum and minimum volumes. After 45 months of follow-up, 31 patients (17%) had major cardiovascular events (death, myocardial infarctions, or stroke). From the two-dimensional echocardiography data, a significant time relationship to cardiovascular events was achieved only by LV end-systolic volume [hazard ratio (HR): 1.047; 95% confidence interval (CI): 0.994-1.083; P = 0.031] and mass (HR: 1.038; CI: 0.993-1.082; P = 0.019), whereas from three-dimensional echocardiography, all the examined variables: LV end-diastolic (HR: 1.014; CI: 1.003-1.025; P = 0.014) and end-systolic volume (HR:1.018; CI: 1.006-1.029; P = 0.003), ejection fraction (HR: 0.032; CI: 0.002-0.565; P = 0.019), mass (HR: 1.030; CI: 1.016-1.045; P < 0.001), LA maximum (HR: 1.055; CI: 1.031-1.080; P < 0.001) and minimum (HR: 1.049; CI: 1.028-1.070; P < 0.001) volumes, were found to bear a significant relationship to cardiovascular events. By multivariate analysis, three-dimensional echocardiography derived LA minimum volume was identified as the best independent predictor of adverse cardiovascular events (HR: 1.217; CI: 1.075-1.378; P = 0.002).
Conclusion:
Owing to a superior accuracy, three-dimensional echocardiography derived parameters and most notably LA minimum volume provide more relevant information on outpatient prognosis.
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