Despite significant improvements for earlier detection of and medical therapies for heart failure, a recent American Heart Association (AHA) study stated that the actual incidence of heart failure has not declined. Of interest is the fact that the AHA found hypertension precedes development of heart failure in 91% of cases. The increasing prevalence of these combined disease states escalates the cost of national healthcare. Further, many patients not compliant with medical therapies and lifestyle changes elevate their risk of continuing progression of their heart failure, eventually requiring device implantation. These devices capable of defibrillation (implantable cardioverter defibrillators, ICDs) and cardiac resynchronization therapy (CRT) offer proven benefits in length and quality of life for many, but also increase the financial burden of providing such medical care.
The presence of such therapeutic techniques that improve survivability without consecutive decline in prevalence offers the medical community a significant challenge: to detect and treat heart failure at its earliest stages in the hope of reversing the upward curve in this burgeoning patient population.
Dramatic improvements in applications and clinical experience regarding the use of transthoracic 3-D cardiac ultrasound is well documented. Recently, the American Society of Echocardiography (ASE) endorsed the use of 3-D transthoracic echocardiography (TTE) in clinical practice for accurate evaluation of cardiac mass, left ventricular (LV) volumetric function analysis, and assessment of valvular disease. Each of these applications provides critical physiological data that may be followed serially in the progression or regression of heart failure.
One of the known hallmarks in chronic hypertension is the increase of gross LV cardiac mass, coupled with diastolic dysfunction. In fact, past studies have demonstrated increased morbidity and mortality in this population. Where common 2-D echocardiography measures (M-mode) yield gross estimations of LV mass, 3-D echocardiography provides rapid objective measurements derived from the identical wide-angle acquisition from which volumetric data are obtained. Along this continuum, actual scanning time will become progressively shortened as 3-D echocardiography applications and processing speed improve.
The importance of immediate and safe availability in obtaining such serial clinical measurements may best be highlighted in a progressive algorithm of the average referral patient from the primary care physician for cardiology consultation. This patient might be a middle-aged male of 49 years with hypertension (160/95), who is moderately obese, and who has relatively poor lifestyle habits.