Recent studies have reported an increased use of 3D stress echo in the diagnosis of coronary artery disease. This method really is ready for use in clinical practice?
The following paper is a review of the applications of real-time three-dimensional echocardiography in stress testing:
Real-Time Three-Dimensional Stress Echocardiography
A Review of Current Applications
Shin Takuma M.D.,
Carol Cardinale M.D. and
Shunichi Homma M.D.*
Article first published online: 13 JUL 2007
Echocardiography, 17, Issue 8, pages 791–794, November 2000
Stable CAD never killed anyone. Neither PCI nor ACB prolongs life in patients with stable CAD and are indicated only in patients with intractable symptoms. So any test for diagnosing stable CAD, including 3D stress echo should only be directed at this small group of patients.
I agree with Colin, and please consider me being an echo man with a 25-year clinical experience. ACS? mostly angiography. CABG surgically intractable patients? Just go on with medications. Let's try and make it easy
Basically the 3D imagination of the LV can be divided in three different techniques: the three apical 2D planes including all 3 dimensions is one, this is our daily routine to detect ischemic areas under exercise conditions. The other technique uses a 4D-transducer (3 morphological dimensions + time) to produce all three planes out of one cardiac circle. This is more difficult to gain good images as resolution decreases, but may be an option in cases with rhythm problems. The third technique is for my opinion the worst one, namely the 3D sequence showing the perspective view of the LV threedimensionally in one picture. This sequence suffer from poor morphological and time resolution (frame rate is too low) up to now. For my personal opinion this option is therefore not really ready for daily use, only for scientific evaluation at most.
Therefore I would recommend the good old three apical and the parasternal long and short axis planes with high morphological and time resolution up to now.