3D is a feasible and more reproducible method than 2D echocardiography for in-training echocardiographers to follow-up patients with heart failure with reduced ejection fraction (original) (raw)
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Left ventricular ejection fraction and volumes: It depends on the imaging method
2014
Background and Methods: In order to provide guidance for using measurements of left ventricular (LV) volume and ejection fraction (LVEF) from different echocardiographic methods a PubMed review was performed on studies that reported reference values in normal populations for two-dimensional (2D ECHO) and three-dimensional (3D ECHO) echocardiography, nuclear imaging, cardiac computed tomography, and cardiac magnetic resonance imaging (CMR). In addition all studies (2 multicenter, 16 single center) were reviewed, which included at least 30 patients, and the results compared of noncontrast and contrast 2D ECHO, and 3D ECHO with those of CMR. Results: The lower limits for normal LVEF and the normal ranges for end-diastolic (EDV) and end-systolic (ESV) volumes were different in each method. Only minor differences in LVEF were found in studies comparing CMR and 2D contrast echocardiography or noncontrast 3D echocardiography. However, EDV and ESV measured with all echocardiographic methods were smaller and showed greater variability than those derived from CMR. Regarding agreement with CMR and reproducibility, all studies showed superiority of contrast 2D ECHO over noncontrast 2D ECHO and 3D ECHO over 2D ECHO. No final judgment can be made about the comparison between contrast 2D ECHO and noncontrast or contrast 3D ECHO. Conclusion: Contrast 2D ECHO and noncontrast 3D ECHO show good reproducibility and good agreement with CMR measurements of LVEF. The agreement of volumes is worse. Further studies are required to assess the clinical value of contrast 3D ECHO as noncontrast 3D ECHO is only reliable in patients with good acoustic windows. (Echocardiography 2014;31:87-100)
The American journal of …, 2005
End-diastolic volume and end-systolic volume were measured in 35 consecutive patients with cardiomyopathy using 2-dimensional (2-D) and 3-dimensional (3-D) echocardiography (2, 4, and 8 planes) and cardiac magnetic resonance imaging. Three-dimensional echocardiography correlates better with magnetic resonance imaging than does 2-D echocardiography. Its accuracy improves with the increase in the number of planes used. Two-dimensional echocardiography underestimates volumes, mainly in the subgroup with an ejection fraction of <50%, whereas 3-D echocardiography does not, if enough planes are used. However, in patients with an end-diastolic volume >150 ml, the underestimation of 3-D echocardiography is statistically significant. Increasing the number of planes to 8 reduces this bias. Conversely, patients with an end-diastolic volume <150 ml are accurately studied with just 4 planes. ᮊ2005 by
The American Journal of Cardiology, 1998
T hree-dimensional echocardiography (3DE) allows for integration and display of information from multiple planes, minimizes the need for geometric assumptions for the left ventricle, and thus can accurately quantify left ventricular structure and systolic function. [11] Although denser sampling of the left ventricular surface would theoretically provide more accurate measurements of ventricular volumes and ejection fraction (EF), such potential benefits would be achieved at the expense of increased time for image acquisition and data analysis. Studies in experimental animals 14,15 and postmortem human preparations 16 under optimized conditions have suggested that 3 to 12 component image planes are necessary for accurate computation of left ventricular volumes. However, similar data are not available for humans. Accordingly, we examined the relation between number of component planes used for 3DE and accuracy in estimating left ventricular end-diastolic volume, end-systolic volume, and EF in humans using cardiac magnetic resonance imaging (MRI) as the reference standard. • • • Forty-one adult subjects (32 men, aged 39 Ϯ 19 years [range 24 to 77]), all in sinus rhythm at the time of imaging, underwent transthoracic 3DE and cardiac MRI within 2 hours. There were 17 subjects (41%) with "abnormal" hearts, 14 (34%) with EF Ͻ55%, 13 with dilated left ventricle (end-diastolic volume Ͼ90 ml/m 2 ), and 7 (17%) with regional left ventricular systolic dysfunction. None of the subjects had any MRI contraindications and written informed consent was obtained before participation. The study protocol was approved by the hospital committee on clinical investigation.
Frontiers in Cardiovascular Medicine
ObjectivesWe sought to analyze if left ventricular (LV) volumes and ejection fraction (EF) measured by three-dimensional echocardiography (3DE) have incremental prognostic value over measurements obtained from two-dimensional echocardiography (2DE) in patients referred to a high-volume echocardiography laboratory for routine, clinically-indicated studies.MethodsWe measured LV volumes and EF using both 2DE and 3DE in 725 consecutive patients (67% men; 59 ± 18 years) with various clinical indications referred for a routine clinical study.ResultsLV volumes were significantly larger, and EF was lower when measured by 3DE than 2DE. During follow-up (3.6 ± 1.2 years), 111 (15.3%) all-cause deaths and 248 (34.2%) cardiac hospitalizations occurred. Larger LV volumes and lower EF were associated with worse outcome independent of age, creatinine, hemoglobin, atrial fibrillation, and ischemic heart diseases). In stepwise Cox regression analyses, the associations of both death and cardiac hospi...
European Journal of Echocardiography, 2011
We evaluated the ability of a new simplified algorithm for three-dimensional echocardiography (3DE) left ventricular (LV) measurements with minimal operator interaction to be reproducible and robust, independently of the experience. Methods and results A total of 163 subjects were investigated using two-dimensional echocardiography (2DE) and 3DE. The 3D data sets were blindly analysed offline by novice investigators and experts. A subgroup of 30 patients was assessed using cardiac magnetic resonance imaging (CMRI) to compare end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) obtained by 2DE, 3DE, and CMRI. Intra-observer and inter-observer variabilities of 2DE and 3DE measurements were evaluated according to level of experience. Mean time analysis of 3DE data was 23.2 + 6.3 s for the novice and 26.1 + 4.1 s for the expert (P ¼ ns). Correlations (r) and mean error measurements (MEM) between 3DE analysis by experts and novices were 0.91 and 23.5 mL for EDV, 0.97 and 4.3 mL for ESV, and 0.91 and 22.6% for EF, respectively. Correlations between 3DE and CMRI were good with low variability and greater agreement when compared with those between 2DE and CMRI. For the novice, MEM was 221.3 mL for EDV, 215.0 mL for ESV, and 2.3% for EF. MEM and 95% confidence intervals were wider for 2DE vs. CMRI than for 3DE vs. CMRI in relation to both expert and novice. Conclusion This new semi-automated algorithm of LV endocardial border detection based on 3DE data appears suitable for clinical use by either expert or novice investigators with greater reproducibility and time of analysis than 2DE.
Feasibility and clinical decision-making with 3D echocardiography in routine practice
Heart, 2007
Objective: To assess the feasibility and potential impact of routine three-dimensional (3D) echocardiographic assessment of left ventricular (LV) ejection fraction and volumes on clinical decision-making. Methods: Patients referred to three hospital-based echocardiography laboratories underwent 2D echocardiography (2DE) and 3D echocardiography (3DE). Feasibility was assessed in a group of 168 unselected patients and decision-making assessed within an expanded group of 220 patients. The time for acquisition and measurement was obtained. Feasibility was defined by ability to measure LV parameters. The potential of 3DE to alter clinical decisions based on 2DE was evaluated by the ability to identify four clinically relevant measurement thresholds: (1) LV end-systolic volume (LVESV) .50 ml/ m 2 (indication for surgery in regurgitant valve disease); (2) LVESV .30 ml/m 2 (prognosis after infarction); (3) LV ejection fraction (LVEF) ,35% (indication for implantable defibrillator); and (4) LVEF ,40% (indication for heart failure treatment). Results: 3DE was technically feasible in 83% of unselected patients. The additional time for 3D acquisition and measurement was available in 184 patients and was 5.4 (SD 2.0) minutes. The use of 3DE changed categorisation in between 6-11% of patients. Within threshold categories, 3D reallocated 17.5% (11/63) of patients with LVEF ,35%, 16.1% (13/81) for LVEF ,40%, 12.4% (13/105) for LVESV .30 ml/m 2 and 8.5% (5/59) for LVESV .50 ml/m 2. Most of the impact of 3D was within 10 ml/m 2 of selected volume thresholds (>75%) and 10% of EF thresholds (.80%). Conclusion: Measurement of LV volumes and EF by 3DE is clinically feasible and has the potential to significantly alter clinical decision-making.