Clinical Investigation
Left Ventricular Function: Novel Approaches
Feasibility and Accuracy of Automated Software for Transthoracic Three-Dimensional Left Ventricular Volume and Function Analysis: Comparisons with Two-Dimensional Echocardiography, Three-Dimensional Transthoracic Manual Method, and Cardiac Magnetic Resonance Imaging

https://doi.org/10.1016/j.echo.2017.06.026Get rights and content

Highlights

  • The authors analyzed the feasibility and accuracy of a new echocardiographic 3D automatic MBA for LV volume and functional evaluation.

  • The new automatic method was applied in a large population and enabled LV volume and LVEF measurements in a few seconds.

  • The authors tested and found the best setting of the slider position for the automatic definition of LV wall borders, optimizing correlation between the new method and 3D traditional full-volume or CMR.

Background

Recently, a new automated software package (HeartModel) was developed to obtain three-dimensional (3D) left ventricular (LV) volumes using a model-based algorithm (MBA) with a “one-button” simple system and user-adjustable slider. The aims of this study were to verify the feasibility and accuracy of the MBA in comparison with other commonly used imaging techniques in a large unselected population, to evaluate possible accuracy improvements of free operator border adjustments or changes of the slider's default position, and to identify differences in method accuracy related to specific pathologies.

Methods

This prospective study included consecutive 200 patients. LV volumes and ejection fraction were obtained using the MBA and compared with the two-dimensional biplane method, the 3D full-volume (3DFV) modality, and, in 90 of 200 cases, cardiac magnetic resonance (CMR) measurements. To evaluate the optimal position of the slider with respect to the 3DFV and CMR modalities, a set of threefold cross-validation experiments was performed. Optimized and manually corrected LV volumes obtained using the MBA were also tested. Linear correlation and Bland-Altman analysis were used to assess intertechnique agreement.

Results

Automatic volumes were feasible in 194 patients (94.5%), with a mean processing time of 29 ± 10 sec. MBA-derived volumes correlated significantly with all evaluated methods, with slight overestimation of two-dimensional biplane and slight underestimation of CMR measurements. Higher correlations were found between MBA and 3DFV measurements, with negligible differences both in volumes (overestimation) and in LV ejection fraction (underestimation), respectively. Optimization of the user-adjustable slider position improved the correlation and markedly reduced the bias between the MBA and 3DFV or CMR. The accuracy of MBA volumes was lower in some pathologies for incorrect definition of LV endocardium.

Conclusions

The MBA is highly feasible, reproducible, and rapid, and it correlates highly with the traditional 3DFV method. It may represent a valid alternative to 3DFV measurement for everyday clinical use.

Section snippets

Methods

We prospectively recruited 200 consecutive patients in sinus rhythm referred to the echocardiography laboratory of Centro Cardiologico Monzino of Milan for measurement of LV volumes and LVEF. After the exclusion of six patients with technically inadequate echocardiographic images, a study group of 194 patients remained who underwent 2D and 3D echocardiography.

For clinical reasons, CMR studies were performed in 90 of these 194 patients. The population consisted of 34 normal subjects and 160

Results

Table 1 shows the clinical characteristic of the study patients. At least one good MBA reconstruction was feasible in 189 of 200 cases. After the exclusion of six patients with technically inadequate echocardiographic images, a study group of 194 patients underwent 2DE and 3DE. However despite satisfactory acquisition, in three patients, MBA reconstruction was not obtained, because of incorrect recognition of LV ventricular apex or ventricular-atrial junction. In two cases, the MBA was not

Discussion

The main findings of this study are as follows: (1) HeartModel automatic measurement of LV volumes is feasible in a large unselected population, and the duration of analysis is very short (29 ± 10 sec); (2) there are high correlations between MBA LV volumes and the “traditional” 3D echocardiographic semiautomatic methods (3DFV), and these correlations further improve with optimal slider position; (3) there is also a good correlation between MBA and CMR, although a slight underestimation of

Conclusions

Three-dimensional transthoracic echocardiography with fully automated quantification software is a rapid, feasible, and reliable way to measure LV volumes. Thus, it is a potential new approach for left chamber quantification in patients undergoing transthoracic echocardiography.

References (27)

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    Citation Excerpt :

    We excluded one article that described only left atrial volumes. After reading the full text, 12 articles with 616 subjects were selected for analysis [8–19]. In the 12 studies, patients were included if they were in sinus rhythm or atrial fibrillation, and agreed to participate; therefore these patients included ischemic heart disease, valvular heart disease, dilated cardiomyopathy, pericardial disease, hypertrophic cardiomyopathy, and secondary cardiomyopathy.

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Dr. Lang is a member of the speakers' bureau of Philips (Best, The Netherlands).

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