by Karima Addetia, MD and Roberto M. Lang, MD
Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL

Clinical Case

  • 70 year-old female admitted with chest pain associated with a small rise in troponin
  • No significant past medical history
  • EKG:


2D 4-chamber view with and without myocardial contrast revealing apical wall motion abnormalities which do not conform to the distribution of a single coronary artery.

Coronary angiogram revealed normal coronaries. LV gram showed apical akinesis with relative preservation of the wall motion at the base. LVEDP was 25 mmHg, LVEF 25-30%.



Using 3D full volume of the left ventricle it is possible to obtain an appreciation for regional LV function. Note the basal LV segments contract normally while the apical segments exhibit minimal or no contraction capacity

Regional LV function (as measured using ejection fraction) at the base, mid and apical portions of the LV at the time of presentation (red) and after three weeks follow-up (green). The regional ejection fraction at the base is no different at presentation and on follow-up while mid and apical regional ejection fraction both improve on follow-up.

Key Messages

2D/Doppler echocardiography enabled:

  • Identification of the wall motion abnormality
  • Quantification of LV ejection fraction and any co-existing valvulopathy
  • Assessment of complications including outflow tract obstruction if present

3D echocardiography allowed:

  • Regional function analysis at baseline and follow-up for more detailed assessment of LV dysfunction
  • 3DE provides new tools suitable for objective, quantitative serial assessment of this disorder