Accuracy of three-dimensional echocardiography with unrestricted selection of imaging planes for measurement of left ventricular volumes and ejection fraction.

BACKGROUND Accurate, reproducible, noninvasive determination of left ventricular (LV) volumes and ejection fraction (EF) is important for clinical assessment, risk stratification, selection of therapy, and serial monitoring of patients with cardiovascular disease. Three-dimensional echocardiography (3DE) approaches have demonstrated significantly greater accuracy than current clinical 2DE, but the clinical utility of 3DE has been limited because of the need for substantial modifications to scanning technique (eg, all image acquisition from a single acoustic window) or cumbersome additional hardware. We describe a novel 3DE system without these limitations and its application to patients. METHODS AND RESULTS Twenty-five patients were examined by 3DE, 2DE, and magnetic resonance imaging (MRI). The 3DE system used a magnetic scanhead tracking device, and volumes were computed with a novel deformable shell model. End-diastolic volumes and EF by MRI ranged from 96 to 375 mL and 18% to 73%, respectively. There was excellent correlation, without statistically significant differences, between MRI and 3DE for end-systolic volume (ESV) (r(2) = 0.99) and end-diastolic volume (EDV) (r(2) = 0.98), ventricular stroke volume (SV) (r(2) = 0.93), and EF (r(2) = 0.97), with standard error estimates less than 10 mL for volumes and 3% for EF. Conventional 2DE consistently underestimated volumes (EDV, P <.01; ESV, P <.01; SV, P <.05); correlations with MRI were r(2) = 0.91 for ESV, r(2) = 0.88 for EDV, r(2) = 0.62 for SV, and r(2) = 0.72 for EF. Standard error estimates ranged from 16 to 20 mL for ventricular volumes and 9% for EF. Interobserver variability was reduced 3-fold with use of 3DE. CONCLUSIONS The novel 3DE system allows unrestricted selection and combination of acoustic windows in a single examination, improves accuracy of estimates of LV volumes and EF 3-fold compared with 2DE, and is practical for routine clinical assessment of LV size and function in patients with a wide range of cardiac pathology.

[1]  M. Quiñones,et al.  Effects of long-term enalapril therapy on cardiac structure and function in patients with left ventricular dysfunction. Results of the SOLVD echocardiography substudy. , 1995, Circulation.

[2]  D F Leotta,et al.  Quantitative three-dimensional echocardiography by rapid imaging from multiple transthoracic windows: in vitro validation and initial in vivo studies. , 1997, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[3]  N. Reichek,et al.  Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. , 1989, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[4]  Chikai J. Ohazama,et al.  Real-time three-dimensional echocardiography for measurement of left ventricular volumes. , 1999, The American journal of cardiology.

[5]  S. Nelson,et al.  Evaluation of left ventricular volume and mass with breath-hold cine MR imaging. , 1993, Radiology.

[6]  Alistair A. Young,et al.  Epicardial surface estimation from coronary angiograms , 1989, Comput. Vis. Graph. Image Process..

[7]  J. Yao,et al.  Three-dimensional echocardiography. , 1998, Current opinion in cardiology.

[8]  D. King,et al.  Three‐dimensional spatial registration and interactive display of position and orientation of real‐time ultrasound images. , 1990, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[9]  J. Cohn,et al.  Mild systolic dysfunction in heart failure (left ventricular ejection fraction >35%): baseline characteristics, prognosis and response to therapy in the Vasodilator in Heart Failure Trials (V-HeFT) , 1996, Journal of the American College of Cardiology.

[10]  R. Parker,et al.  Relation between the number of image planes and the accuracy of three-dimensional echocardiography for measuring left ventricular volumes and ejection fraction. , 1998, The American journal of cardiology.

[11]  R A Levine,et al.  Three-dimensional echocardiography. In vivo validation for right ventricular volume and function. , 1993, Circulation.

[12]  Chikai J. Ohazama,et al.  Assessment of regional wall motion abnormalities with real-time 3-dimensional echocardiography. , 1999, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[13]  Quantitative two-dimensional echocardiographic measurements are major predictors of adverse cardiovascular events after acute myocardial infarction. The protective effects of captopril. , 1994, Circulation.

[14]  Alex Pentland,et al.  Closed-Form Solutions for Physically Based Shape Modeling and Recognition , 1991, IEEE Trans. Pattern Anal. Mach. Intell..

[15]  D. King,et al.  Left ventricular volume and endocardial surface area by three-dimensional echocardiography: comparison with two-dimensional echocardiography and nuclear magnetic resonance imaging in normal subjects. , 1993, Journal of the American College of Cardiology.

[16]  E A Geiser,et al.  Dynamic three-dimensional echocardiographic reconstruction of the intact human left ventricle: technique and initial observations in patients. , 1982, American heart journal.

[17]  F J Ten Cate,et al.  Accurate measurement of left ventricular ejection fraction by three-dimensional echocardiography. A comparison with radionuclide angiography. , 1996, Circulation.

[18]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[19]  N G Pandian,et al.  Three-dimensional echocardiographic estimation of infarct mass based on quantification of dysfunctional left ventricular mass. , 1997, Circulation.

[20]  R A Levine,et al.  A New Integrated System for Three-Dimensional Echocardiographic Reconstruction: Development and Validation for Ventricular Volume with Application in Human Subjects , 1993, Journal of the American College of Cardiology.

[21]  M. Domanski,et al.  Ejection fraction and risk of thromboembolic events in patients with systolic dysfunction and sinus rhythm: evidence for gender differences in the studies of left ventricular dysfunction trials. , 1997, Journal of the American College of Cardiology.

[22]  Jonathan Ophir,et al.  An Algorithm for Volume Estimation Based on Polyhedral Approxi mation , 1980, IEEE Transactions on Biomedical Engineering.

[23]  J. Rivera,et al.  Three-dimensional echocardiography: the influence of number of component images on accuracy of left ventricular volume quantitation. , 1996, Journal of the American Society of Echocardiography.

[24]  J. Cohn,et al.  Erratum: Mild systolic dysfunction in heart failure (left ventricular ejection fraction > 35%): Baseline characteristics, prognosis and response to therapy in the Vasodilator in Heart Failure Trials (V-HeFT) (J Am Coll Cardiol (1996), 27:642-9) , 1996 .