The thorny way of 3D strain from research to clinical use: are we getting closer?

T he ability to imagine a 3-dimensional (3D) image of the heart was one of the earliest recognized benefits of 2-dimensional (2D) echocardiography at its inception 40 years ago. The ability to build such an image in real time has been a remarkable feat of image processing in the past decade. Intuitively, 3D imaging is the future of echocardiography, and the superiority of this method compared with 2D techniques is most apparent in the assessment of structural abnormalities (e.g., valvular heart disease and septal defects). In addition to these rendered images, quantitation of volumebased measurements, such as ejection fraction (EF), is better performed by 3D than with 2D echocardiographic techniques. After its development in 2D echocardiography, measurement of myocardial strain has recently been implemented in 3D echocardiography by multiple vendors. However, even though the 3D strain technique has been available for some years, many experts have considered that it was not yet ready for clinical implementation.