Real-time three-dimensional echocardiography for measurement of left ventricular volumes

doi:10.1016/S0002-9149(99)00591-3

The American Journal of Cardiology

Volume 84, Issue 12, 15 December 1999, Pages 1434-1439

https://doi.org/10.1016/S0002-9149(99)00591-3 Get rights and content

Abstract

Left ventricular (LV) volumes are important prognostic indexes in patients with heart disease. Although several methods can evaluate LV volumes, most have important intrinsic limitations. Real-time 3-dimensional echocardiography (RT3D echo) is a novel technique capable of instantaneous acquisition of volumetric images. The purpose of this study was to validate LV volume calculations with RT3D echo and to determine their usefulness in cardiac patients. To this end, 4 normal subjects and 21 cardiac patients underwent magnetic resonance imaging (MRI) and RT3D echo on the same day. A strong correlation was found between LV volumes calculated with MRI and with RT3D echo (r = 0.91; y = 20.1 + 0.71x; SEE 28 ml). LV volumes obtained with MRI were greater than those obtained with RT3D echo (126 ± 83 vs 110 ± 65 ml; p = 0.002), probably due to the fact that heart rate during MRI acquisition was lower than that during RT3D echo examination (62 ± 11 vs 79 ± 16 beats/min; p = 0.0001). Analysis of intra- and interobserver variability showed strong indexes of agreement in the measurement of LV volumes with RT3D echo. Thus, LV volume measurements with RT3D echo are accurate and reproducible. This technique expands the use of ultrasound for the noninvasive evaluation of cardiac patients and provides a new tool for the investigational study of cardiovascular disease.

Section snippets

RT3D echo imaging

The method of RT3D echo imaging was first developed in the Center for Emerging Cardiovascular Technologies at Duke University17, 18 and is based on the use of a 2-dimensional phased-array transducer. These 2-dimensional arrays consist of a 43 × 43 element matrix with elements measuring 0.3 × 0.3 mm. For the present studies, a 14-mm array was used with a center frequency of 2.5 MHz (Volumetrics Medical Imaging, model 1, Durham, North Carolina). Figure 1 shows a 2-dimensional array and the

Results

Both MRI and RT3D echo studies were completed in each subject within 4 hours. Eleven subjects underwent MRI examination before RT3D echo, whereas the remaining 14 subjects underwent RT3D echo examination first. The average heart rate during the MRI acquisition was significantly lower than that recorded at the time of the RT3D echo examination (62 ± 11 vs 79 ± 16 beats/min, respectively; p = 0.0001), and there was no significant correlation between heart rate values measured during the

Discussion

Findings in the present study demonstrate that RT3D echo, a novel technique capable of providing noninvasive evaluation of cardiac anatomy in real time, is accurate and reproducible for the quantitative assessment of LV volumes. Thus, in a group of patients with different forms of cardiac disease who underwent MRI and RT3D echo examinations on the same day, a strong correlation was observed between the measurements of LV volumes provided by the 2 techniques. Further, analysis of intra- and

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Cited by (115)

Impact of Multimodality Imaging on the Diagnosis of Left Ventricular Apical Thrombus in Patients After Anterior Myocardial Infarction
2022, American Journal of the Medical Sciences
The presence of the left ventricle (LV) apical thrombus is one of the most critical complications of anterior myocardial infarction (MI). Due to the high risk of systemic embolization, the determination of LV apical thrombus (LVAT) is essential. We aimed to compare the two-dimensional echocardiography (2DE), contrast-2DE and real-time three-dimensional echocardiography (RT-3DE) in the diagnosis of LVAT and determine which imaging modality is superior.
The study was designed as a prospective cohort study, and 161 patients were included. Patients with low ejection fraction (< 40%) and LV apical wall motion abnormality (severe hypokinetic, akinetic or dyskinetic) were included. 2DE, contrast-2DE, RT-3DE, and magnetic resonance imaging (MRI) were performed on all patients within one month after anterior MI.
Transthoracic 2DE detected thrombi in 29 patients, contrast-2DE detected thrombi in 33 patients, RT-3DE detected thrombi in 32 patients, and MRI detected thrombi in 28 patients. While MRI is accepted as the gold standard for non-invasive imaging, the specificity of detecting thrombus with 2DE is 90%, and the sensitivity is 57%, contrast-2DE had 82% sensitivity and 92% specificity for the detection of LVAT. The specificity for detecting thrombus with RT-3DE is 93%, and the sensitivity is 85%. Accuracy was 84%, 90% and 92% with 2DE, contrast-2DE and RT-3DE, respectively.
We found that RT-3DE was more sensitive and more specific than 2DE and contrast-2DE in the diagnosis of LVAT. The diagnostic accuracy of RT-3DE was higher than 2DE and contrast-2DE for LVAT.
Real-time three-dimensional echocardiography: Never before clinical efficacy looked so picturesque
2015, International Journal of Cardiology
Over the years echocardiography has served the clinical cardiologist in a variety of clinical scenarios, assisting in patient diagnostic and therapeutic managements. With the advent of novel imaging modalities we now experience the renascence of imaging. As a result, the field of cardiovascular medicine is strongly connected to imaging, which in turn requires thorough knowledge of each modality's distinct advantages and limitations. In this concise review we present up-to-date knowledge with regard to real-time three-dimensional echocardiography and its implementation in clinical practice.
Incremental value of three-dimensional echocardiography in the evaluation of left ventricular size in mitral regurgitation: A follow-up study after mitral valve surgery
2014, Journal of the American Society of Echocardiography
Increased left ventricular (LV) dimensions are an indication for surgery in patients with asymptomatic mitral regurgitation, but M-mode or two-dimensional measurements have known limitations. The aim of this study was to determine the value of three-dimensional echocardiography in predicting postoperative outcomes after mitral surgery.
Sixty-seven patients with severe asymptomatic or minimally symptomatic mitral regurgitation (69% men; mean age, 62 ± 13 years) who underwent mitral valve surgery from January 2010 to December 2011 were studied. In addition to standard echocardiography, baseline three-dimensional echocardiography was performed for accurate quantification of LV size. Patients were followed over a median time of 1 month (interquartile range, 0–8 months) for postoperative development of atrial fibrillation or LV dysfunction. A multivariate regression analysis was performed to identify associations with events.
Postoperative LV dysfunction developed in 15 patients (22%), and 21 patients (31%) had postoperative atrial fibrillation. There was no association between two-dimensional end-systolic volume index and outcomes (hazard ratio, 1.02; P = .18). Postoperative atrial fibrillation or LV dysfunction was associated with baseline three-dimensional LV end-systolic volume index (hazard ratio, 1.06; 95% confidence interval, 1.04–1.16), independent of age and presence of coronary artery disease. LVESVi ≥ 40 mL/m² was the best cutoff value to predict postoperative events (sensitivity, 80%; specificity, 85%). After adding LVESVi to a model containing clinical and echocardiographic parameters, net reclassification improvement was 0.27 (95% confidence interval, 0.25–0.29; P = .024).
LVESVi from three-dimensional echocardiography is an independent predictor of postoperative outcomes in patients with severe mitral regurgitation that is incremental to other clinical and echocardiographic variables.
Evaluation of automated measurement of left ventricular volume by novel real-time 3-dimensional echocardiographic system: Validation with cardiac magnetic resonance imaging and 2-dimensional echocardiography
2013, Journal of Cardiology
Traditional 3-dimensional echocardiography (3DE) with volumetric scanning technique requires several heart cycles for full-volume acquisition and complicated manual contouring of left ventricular (LV) endocardium. The new real-time 3DE (RT3DE) system allows acquisition of an instantaneous full-volume dataset in a single heart cycle and automated measurement of LV volume by the algorithm software. However, it has not been evaluated adequately whether automated measurement by RT3DE has better agreement with cardiac magnetic resonance imaging (CMR) than 2-dimensional echocardiography (2DE) with CMR.
This study aimed to evaluate the accuracy of automated measurement of LV volume using RT3DE compared with 2DE and CMR.
Forty-four consecutive patients who underwent RT3DE, 2DE, and CMR were evaluated in this study. The feasibility of automated measurement by RT3DE was 93.2% and the mean operation time was 6 min. LV volume and ejection fraction (EF) from semi-automated measurement [end-diastolic volume: r = 0.96, limits of agreement (LOA) −30.5 to 39.3 ml; end-systolic volume: r = 0.97, LOA −22.6 to 32.7 ml; EF: r = 0.90, LOA −16.1 to 14.2%, respectively] had better agreement with CMR than those from 2DE (r = 0.87, LOA −50.5 to 72.2 ml; r = 0.93, LOA −34.1 to 65.2 ml; r = 0.89, LOA −20.9 to 10.0%, respectively).
Semi-automated measurement by RT3DE has better agreement with CMR than 2DE in LV volume and EF. In addition, it is simple to operate and acceptable in feasibility for the clinical setting although there may be room for further learning required to incorporate small hypertrophic LV into the automated algorithm software.
Head-to-head comparison of left ventricular function assessment with 64-row computed tomography, biplane left cineventriculography, and both 2- and 3-dimensional transthoracic echocardiography: Comparison with magnetic resonance imaging as the reference standard
2012, Journal of the American College of Cardiology
This study was designed to compare the accuracy of 64-row contrast computed tomography (CT), invasive cineventriculography (CVG), 2-dimensional echocardiography (2D Echo), and 3-dimensional echocardiography (3D Echo) for left ventricular (LV) function assessment with magnetic resonance imaging (MRI).
Cardiac function is an important determinant of therapy and is a major predictor for long-term survival in patients with coronary artery disease. A number of methods are available for assessment of function, but there are limited data on the comparison between these multiple methods in the same patients.
A total of 36 patients prospectively underwent 64-row CT, CVG, 2D Echo, 3D Echo, and MRI (as the reference standard). Global and regional LV wall motion and ejection fraction (EF) were measured. In addition, assessment of interobserver agreement was performed.
For the global EF, Bland-Altman analysis showed significantly higher agreement between CT and MRI (p < 0.005, 95% confidence interval: ±14.2%) than for CVG (±20.2%) and 3D Echo (±21.2%). Only CVG (59.5 ± 13.9%, p = 0.03) significantly overestimated EF in comparison with MRI (55.6 ± 16.0%). CT showed significantly better agreement for stroke volume than 2D Echo, 3D Echo, and CVG. In comparison with MRI, CVG—but not CT—significantly overestimated the end-diastolic volume (p < 0.001), whereas 2D Echo and 3D Echo significantly underestimated the EDV (p < 0.05). There was no significant difference in diagnostic accuracy (range: 76% to 88%) for regional LV function assessment between the 4 methods when compared with MRI. Interobserver agreement for EF showed high intraclass correlation for 64-row CT, MRI, 2D Echo, and 3D Echo (intraclass correlation coefficient >0.8), whereas agreement was lower for CVG (intraclass correlation coefficient = 0.58).
64-row CT may be more accurate than CVG, 2D Echo, and 3D Echo in comparison with MRI as the reference standard for assessment of global LV function.
Assessment of left ventricular regional wall motion and ejection fraction with low-radiation dose helical dual-source CT: Comparison to two-dimensional echocardiography
2011, Journal of Cardiovascular Computed Tomography
Electrocardiographic (ECG)–based tube current modulation during cardiac CT reduces radiation exposure but significantly increases noise in parts of the cardiac cycle where tube current is minimized.
We evaluated the effect of maximal ECG-based tube current reduction on left ventricular (LV) regional wall motion assessment and ejection fraction (EF) by comparing low-radiation helical dual-source CT (DSCT) to 2-dimensional transthoracic echocardiography (2D-TTE).
We studied 83 consecutive patients (15 with prior myocardial infarction) who underwent helically acquired DSCT coronary angiography with maximal ECG-based tube current modulation (low-radiation helical DSCT) and 2D-TTE within a 6-month period (median, 1 day), without any change in clinical status between the studies. In all patients, full tube current was applied only at 70% of the R-R interval, with minimal tube current (4% of maximum) in all other parts of the cardiac cycle. Reduced tube voltage (100 kVp) was combined with the maximal dose modulation in 34 patients. DSCT datasets were evaluated by a blinded, experienced cardiologist. Regional wall motion was assessed with the standard 17-segment model, with each segment scored as normal, hypokinetic, akinetic, and dyskinetic.
Mean effective radiation dose for the low-radiation helical DSCT was 5.2 ± 1.7 mSv. Regional wall motion was evaluable in all segments on low-radiation helical DSCT. There was excellent agreement of wall motion scoring by low-radiation helical DSCT and 2D-TTE in 1382 of 1411 segments (98%; Cohen’s κ value 0.83; 95% confidence interval, 0.76–0.89; P < 0.0001). Mean LVEF was 67.6% ± 10.3% on low-radiation helical DSCT and 61.8% ± 10.3% on 2D-TTE (P < 0.0001).
Low-radiation dose helical coronary CT angiography with maximal ECG-based tube current modulation is comparable to 2D-TTE for regional wall motion and EF assessment.

View all citing articles on Scopus

^☆: This work was supported in part by Grant HL-58104 form the National Heart, Lung, and Blood Institute, Bethesda, Maryland; and Grant CDR8622201 from the National Science Foundation, Arlington, Virginia.

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MethodsReal-time three-dimensional echocardiography for measurement of left ventricular volumes☆

Abstract

Section snippets

RT3D echo imaging

Results

Discussion

Am J Cardiol

Am J Cardiol

Am Heart J

J Am Coll Cardiol

Am Heart J

J Am Soc Echocardiogr

J Am Soc Echocardiogr

Ultrasound Med Biol

Am J Cardiol

J Magn Reson Imaging

Valvular heart disease

N Engl J Med

Noninvasive imaging in acute coronary disease

Circulation

Methods
Real-time three-dimensional echocardiography for measurement of left ventricular volumes☆