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In fact, reduction in long axis function is often associated with normal wall thickening and with exaggerated amplitude of epicardial motion. In other words, a fall in long axis velocities may be accompanied by an increase in radial velocities and an overall preservation of global left ventricular ejection fraction (LVEF) in early disease [10]. Hence, a reduction in longitudinal s' appears to carry independent prognostic information beyond the impact of LVEF in hypertension [11], heart failure [12] and coronary artery disease [13]. The predictive utility of pulsed Doppler TDI is not restricted to ischaemia; for example, TDI not only falls before any change in LVEF in severe mitral regurgitation [14] but also predicts those patients in whom LVEF will fall following mitral valve replacement.
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3DE has become central to the assessment of valve structure and function. As mitral valve repair becomes more commonplace, accurate pre-operative imaging is vital to surgical planning. 2D transoesophageal echocardiography (TOE) has been the gold standard for mitral valve assessment because it provides high spatial resolution, but 3D transthoracic echocardiography is comparable [31]. 3D transthoracic echocardiography has a proven role in accurate planimetry of mitral and aortic stenosis, and is increasingly used in quantifying the severity of valvular lesions.
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There is extensive evidence to show that the use of contrast improves the accuracy and reliability of echocardiographic assessment of LV volumes and function
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As myocardial contrast echocardiography provides simultaneous assessment of wall motion and resting perfusion, it also adds significantly to the detection of acute coronary syndromes [42]. Since capillary integrity is a vital component of myocardial viability, loss of contrast intensity and reduction in myocardial blood flow is also an accurate measure of scar formation after myocardial infarction, with a predictive accuracy for recovery of function similar to that of gadolinium-enhanced CMR [41].