Original article
Accuracy and Feasibility of Online 3-Dimensional Echocardiography for Measurement of Left Ventricular Parameters

https://doi.org/10.1016/j.echo.2006.04.002Get rights and content

Background

The availability of automated online software may increase the feasibility of real-time 3-dimensional (3D) echocardiography (3DE) for left ventricular (LV) volume calculation in clinical practice. We sought to compare offline and online approaches with magnetic resonance imaging (MRI).

Methods

Patients who presented to the clinical laboratory for evaluation of LV parameters (n = 110, 94 men, age 63 ± 10 years) were studied with 2-dimensional echocardiography, online and offline 3DE, and MRI. The 3DE measurements were obtained by a semiautomated LV border detection based on tracing (online) and edge detection (offline). MRI images were obtained using true free induction steady-state precession during breath hold, with measurement of 3D volumes and ejection fraction (EF).

Results

All echocardiographic techniques underestimated LV volumes, but EF estimations were similar. The best correlation was between MRI versus offline 3DE. The correlation of online 3DE with MRI was significantly better than 2-dimensional echocardiography (end-diastolic volume (EDV) z = 4.2, end-systolic volume (ESV) z = 4.44, EF z = 4.32; all P < .01). However, correlation of offline 3DE with MRI was significantly better than online 3DE (EDV z = 2.57, P < .05; ESV z = 2.42, P < .05; EF z = 3.82, P < .01). Images were considered to be good quality (endocardium visualized in all walls) in 49 patients; discrepancies between online and offline 3DE and MRI were similar in good- and poor-quality images. Wall-motion abnormalities were present in 98 patients; discrepancies with MRI were similar in patients with and without abnormal wall motion.

Conclusions

Online measurement of LV volumes is feasible and more accurate than with 2-dimensional echocardiography. Although the offline approach is more accurate, it is also more time-consuming.

Section snippets

Study Design

We prospectively recruited 117 patients (94 men, age 63 ± 10 years) referred to the echocardiography laboratory for measurement of LV volume and EF. All of these patients were scheduled to undergo 2DE, 3DE, and MRI. The investigations were approved by the ethics committee and all patients gave informed consent.

2DE

An experienced sonographer acquired apical 4- and 2-chamber views of the LV with the patient in the left lateral decubitus position. Harmonic imaging with a transthoracic 3-MHz

Patient Characteristics

Results of MRI, 3DE, and 2DE were analyzed in 110 patients (94 men, age 63 ± 10 years). 7 patients were excluded because of poor image quality on one or more modality. Table 1 summarizes the clinical characteristics, and presence and cause of LV dysfunction; the majority had regional wall-motion abnormalities.

Feasibility of Online 3DE

One patient of the 117 (99%) could not be measured by 2DE because of image quality. We found that 97% were measurable with offline 3DE, and 94% with online 3DE. The 7 patients who could

Discussion

The results of this study indicate that online 3D imaging is a feasible approach for measuring LV parameters. Nonetheless, offline 3DE had a better correlation with less variation from MRI followed by online 3DE, then 2DE. Image quality did not explain the differences between each of the 3DE techniques and MRI.

References (17)

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