Quantitative real-time 3-dimensional stress echocardiography: a preliminary investigation of feasibility and effectiveness.

Use of rapidly emerging real-time 3-dimensional (3D) echocardiography promises to improve the diagnostic accuracy of stress echocardiography (SE). However, widespread acceptance of 3D-SE, based on real-time 3D echocardiography, is hampered in part by lack of efficient, accurate, and objective analysis tools.We propose novel algorithms for interactive visualization, registration (alignment), and quantitative analysis of prestress and poststress real-time 3D echocardiography to facilitate an objective diagnosis. In a preliminary evaluation, two experts independently performed wall-motion analysis in 15 patients with known/suspected coronary artery disease, using the novel quantitative 3D-SE methods.Compared with previously reported values for conventional 2-dimensional SE, improved interexpert agreement (kappa = 0.85) was observed for segment-wise classification of normal/abnormal wall motion using the novel 3D-SE methods. Overall, 6 of 6 patients with abnormal myocardial segments were correctly identified by both experts with 3D-SE, compared with 4 of 6 with conventional 2-dimensional SE.Initial results are promising and indicate the feasibility and potential of our proposed quantitative 3D-SE methodologies for improving diagnosis of wall-motion abnormalities.