Method
Comparison of Contrast Agent–Enhanced Versus Non-Contrast Agent–Enhanced Real-Time Three-Dimensional Echocardiography for Analysis of Left Ventricular Systolic Function

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Ultrasound contrast has shown to improve endocardial border definition. The purpose of this study was to evaluate the value of contrast agent–enhanced versus non-contrast agent–enhanced real-time 3-dimensional echocardiography (RT3DE) for the assessment of left ventricular (LV) volumes and ejection fraction. Thirty-nine unselected patients underwent RT3DE with and without SonoVue contrast agent enhancement and magnetic resonance imaging (MRI) on the same day. An image quality index was calculated by grading all 16 individual LV segments on a scale of 0 to 4: 0, not visible; 1, poor; 2, moderate; 3, good; and 4, excellent. The 3-dimensional data sets were analyzed offline using dedicated TomTec analysis software. By manual tracing, LV end-systolic volume, LV end-diastolic volume, and LV ejection fraction were calculated. After contrast agent enhancement, mean image quality index improved from 2.4 ± 1.0 to 3.0 ± 0.9 (p <0.001). Contrast agent–enhanced RT3DE measurements showed better correlation with MRI (LV end-diastolic volume, r = 0.97 vs 0.86; LV end-systolic volume, r = 0.96 vs 0.94; LV ejection fraction, r = 0.94 vs 0.81). The limits of agreement (Bland-Altman analysis) showed a similar bias for RT3DE images with and without contrast agent but with smaller limits of agreement for contrast agent–enhanced RT3DE. Also, inter- and intraobserver variabilities decreased. In a subgroup, patients with poor to moderate image quality showed an improvement in agreement after administration of contrast agent (±24.4% to ±12.7%) to the same level as patients with moderate to good image quality without contrast agent (±10.4%). In conclusion, contrast agent–enhanced RT3DE is more accurate in assessment of LV function as evidenced by better correlation and narrower limits of agreement compared with MRI, as well as lower intra- and interobserver variabilities.

Section snippets

Methods

Thirty-nine consecutive patients (mean age 58 ± 15 years, range 24 to 79; 34 men) in sinus rhythm were prospectively studied with RT3DE and MRI on the same day. These patients were referred for routine evaluation of cardiac function after myocardial infarction (n = 28), cardiomyopathy (n = 10), and myocarditis (n = 1). No patient was excluded from the study because of echocardiographic image quality. The institutional review board approved the study, and all patients gave informed consent.

RT3DE

Results

The mean time for data analysis ranged from 5 to 20 minutes, depending on image quality. From the total number of 624 segments, 173 segments (28%) had an image quality score <2 without contrast agent enhancement. This number decreased to 69 segments (11%) with contrast agent enhancement. After enhancement, the mean image quality index improved from 2.4 ± 1.0 to 3.0 ± 0.9 (p <0.001). The most profound improvement was seen in the anterior segments (from 1.9 ± 1.4 to 2.6 ± 1.3). A similar

Discussion

Two-dimensional echocardiography remains the most often used imaging modality to assess LV function, but it is limited in accuracy because of geometric assumptions of LV shape and high intra- and interobserver variabilities.8 Improvement in accuracy was shown by 3-dimensional echocardiography because of the absence of these geometric assumptions.5 Despite technologic improvements, image quality remains worse than 2-dimensional echocardiographic imaging. Reliable LV contour detection is possible

References (19)

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