Intervendor Consistency and Accuracy of Left Ventricular Volume Measurements Using Three-Dimensional Echocardiography

Denisa Muraru; Antonella Cecchetto; Umberto Cucchini; Xiao Zhou; Roberto M Lang; Gabriella Romeo; Mani Vannan; Sorina Mihaila; Marcelo Haertel Miglioranza; Sabino Iliceto; Luigi P Badano

doi:10.1016/j.echo.2017.10.010

Intervendor Consistency and Accuracy of Left Ventricular Volume Measurements Using Three-Dimensional Echocardiography

J Am Soc Echocardiogr. 2018 Feb;31(2):158-168.e1. doi: 10.1016/j.echo.2017.10.010. Epub 2017 Dec 8.

Affiliations

¹ Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
² Piedmont Heart Institute, Atlanta, Georgia.
³ University of Chicago Medical Center, Chicago, Illinois.
⁴ Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy; University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
⁵ Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy; Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil.
⁶ Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. Electronic address: lpbadano@gmail.com.

PMID: 29229493
DOI: 10.1016/j.echo.2017.10.010

Abstract

Background: Intervendor consistency of left ventricular (LV) volume measurements using three-dimensional transthoracic echocardiography (3DTTE) has never been reported. Accordingly, we designed a prospective study to (1) compare head-to-head the accuracy of three three-dimensional echocardiography (3DE) systems in measuring LV volumes and ejection fraction (EF) against cardiac magnetic resonance (CMR); (2) assess the intervendor variability of LV volumes and EF; and (3) compare the accuracy of fully automated versus semiautomated (i.e., manually corrected) methods of LV endocardial delineation against CMR.

Methods: We studied 92 patients (64% males, 52 years [95% CI, 20-83]) with a wide range of end-diastolic volumes (from 87 to 446 mL) and EFs (from 16% to 77%) using three different 3DE platforms (iE33; Vivid E9; Acuson SC2000) during the same echo study. CMR was performed within 3 ± 5 hours from the 3DE study in 35 patients.

Results: LV volumes provided by the three 3DE systems correlated with CMR volumes: end-diastolic volume (iE33: R² = 0.93; E9: R² = 0.94; SC2000: R² = 0.94), end-systolic volume (iE33: R² = 0.93; E9: R² = 0.95; SC2000: R² = 0.94), and EF (iE33: R² = 0.79; E9: R² = 0.80; SC2000: R² = 0.77). In the 92 patients studied, LV volumes and EFs measured with the three systems were similar. Use of fully automated endocardial border detection algorithms significantly underestimated LV volumes, and the degree of underestimation was higher with larger LV volumes.

Conclusions: LV volumes and EFs measured with the three 3DE systems are consistent. Fully automated algorithms underestimated LV volumes. Our findings may help in the clinical interpretation of LV parameters obtained using different 3DE systems and encourage the clinical use of 3DTTE.

Keywords: Cardiac magnetic resonance; Ejection fraction; Fully automated; Left ventricle; Repeatability; Reproducibility; Three-dimensional echocardiography; Volumes.

Publication types

Observational Study

MeSH terms

Adult
Aged
Aged, 80 and over
Cardiac Volume / physiology*
Echocardiography, Three-Dimensional / methods*
Female
Heart Diseases / diagnosis*
Heart Diseases / physiopathology
Heart Ventricles / diagnostic imaging*
Heart Ventricles / physiopathology
Humans
Magnetic Resonance Imaging, Cine
Male
Middle Aged
Prospective Studies
ROC Curve
Reproducibility of Results
Stroke Volume / physiology*
Ventricular Function, Left / physiology*
Young Adult