Accuracy and Reproducibility of Quantitation of Left Ventricular Function by Real-Time Three-Dimensional Echocardiography Versus Cardiac Magnetic Resonance

doi:10.1016/j.amjcard.2008.04.062

The American Journal of Cardiology

Volume 102, Issue 6, 15 September 2008, Pages 778-783

https://doi.org/10.1016/j.amjcard.2008.04.062 Get rights and content

The aim of this study was to investigate the accuracy and reproducibility of the quantification of left ventricular (LV) function by real-time 3-dimensional echocardiography (RT3DE) using current state-of-the-art hardware and software. Compared with cardiac magnetic resonance (CMR), previous generations of hardware and software for RT3DE significantly underestimated LV volumes partly because of inherent factors such as limited spatial and temporal resolution. Also, RT3DE volumes were compared with short-axis CMR data, whereas a combined short-axis and long-axis analysis is known to be superior. Twenty-four subjects (mean age 51 ± 12 years, 17 men) in sinus rhythm and with good to excellent 2-dimensional image quality underwent RT3DE and CMR within 1 day. The acquisition of RT3DE data was done with current state-of-the-art hardware and software. Two blinded experts performed off-line LV volume analysis. Global LV volumes were determined from semiautomated border detection on the basis of endocardial speckle tracking with biplane projections using QLAB version 6.0. Volumes derived by magnetic resonance imaging were quantified from combined short-axis and long-axis series. The volume-rate on RT3DE was 33 ± 8 Hz (range 19 to 42). Excellent correlations were found (R² ≥ 0.97) between CMR and RT3DE for global LV end-diastolic volume, LV end-systolic volume, the LV ejection fraction, and LV phase volumes (24 phases/cardiac cycle). Bland-Altman analyses showed mean differences of −7.1 ml, −4.2 ml, 0.2%, and −5.8 ml and 95% limits of agreement of ±19.7 ml, ±8.3 ml, ±6.2%, and ±15.4 ml for global LV end-diastolic volume, LV end-systolic volume, the LV ejection fraction, and LV phase volumes, respectively. Interobserver variability was 5.2% for global LV end-diastolic volume, 6.4% for LV end-systolic volume, and 7.6% for the LV ejection fraction. In conclusion, in patients with good acoustic windows, RT3DE using state-of-the-art technology provides accurate and reproducible measurements of global LV volumes, LV volume changes over time, and the LV ejection fraction.

Section snippets

Study population

The study included 17 patients (mean age 53 ± 15 years, 12 men) with impaired LV systolic function due to ischemic causes in 10 patients (59%) and idiopathic dilated cardiomyopathy in 7 (41%) and 7 healthy volunteers (mean age 41 ± 14 years, 5 men) with normal LV dimensions and function. All participants were in sinus rhythm and had good to excellent 2-dimensional echocardiographic image quality and underwent RT3DE and CMR on the same day (within 2 hours) to ensure comparable hemodynamic

Population characteristics

The mean age of the study participants was 51 ± 12 years, and 71% were men. On RT3DE, the mean LV end-diastolic volume was 213 ± 63 ml (range 122 to 368), the mean LV end-systolic volume was 122 ± 69 ml (range 47 to 318), and the mean LV ejection fraction was 47 ± 15% (range 14% to 66%).

Global volume analysis

Linear regression analysis (Table 1, Figure 2) showed excellent correlations between CMR and RT3DE for global LV end-diastolic volume (r² = 0.98, y = 0.98x − 11 ml, p <0.001), LV end-systolic volume (r² = 0.98,

Discussion

The main finding of the present study is that in patients with good acoustic windows, RT3DE using state-of-the-art technology provides very accurate and reproducible measurements of global LV volumes, LV volume changes over time, and the global LV ejection fraction.

The excellent accuracy and reproducibility of the full LV volume real-time 3-dimensional echocardiographic data sets in the present study parallel the improvements in hardware and software technology but are also a result of a

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MethodAccuracy and Reproducibility of Quantitation of Left Ventricular Function by Real-Time Three-Dimensional Echocardiography Versus Cardiac Magnetic Resonance

Section snippets

Study population

Population characteristics

Global volume analysis

Discussion

Am J Cardiol

J Am Soc Echocardiogr

Int J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Method
Accuracy and Reproducibility of Quantitation of Left Ventricular Function by Real-Time Three-Dimensional Echocardiography Versus Cardiac Magnetic Resonance