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European Heart Journal Advance Access originally published online on November 30, 2005
European Heart Journal 2006 27(4):460-468; doi:10.1093/eurheartj/ehi666
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Rapid online quantification of left ventricular volume from real-time three-dimensional echocardiographic data

Lawrence D. Jacobs1, Ivan S. Salgo2, Sascha Goonewardena1, Lynn Weinert1, Patrick Coon1, Dianna Bardo3, Olivier Gerard4, Pascal Allain4, Jose L. Zamorano5, Leopoldo P. de Isla5, Victor Mor-Avi1 and Roberto M. Lang1,*

1Noninvasive Cardiac Imaging Laboratory, University of Chicago Hospitals, 5841 S. Maryland Avenue, MC 5084, Chicago, IL 60637, USA
2Philips Medical Systems, Andover, MA, USA
3Department of Radiology, University of Chicago, Chicago, IL, USA
4Philips Medical Systems, Paris, France
5University Clinic San Carlos, Madrid, Spain

Received 20 July 2005; revised 24 October 2005; accepted 3 November 2005; online publish-ahead-of-print 30 November 2005.

* Corresponding author. Tel: +1 773 702 1842; fax: +1 773 702 1034. E-mail address: rlang{at}medicine.bsd.uchicago.edu

Aims Determination of left ventricular (LV) volumes and ejection fraction (EF) from two-dimensional echocardiographic (2DE) images is subjective, time-consuming, and relatively inaccurate because of foreshortened views and the use of geometric assumptions. Our aims were (1) to validate a new method for rapid, online measurement of LV volumes from real-time three-dimensional echocardiographic (RT3DE) data using cardiac magnetic resonance (CMR) as the reference and (2) to compare its accuracy and reproducibility with standard 2DE measurements.

Methods and results CMR, 2DE, and RT3DE datasets were obtained in 50 patients. End-systolic and end-diastolic volumes (ESV and EDV) were calculated from the 2DE images using biplane method of disks. ES and ED RT3DE datasets were analysed using prototype software designed to automatically detect the endocardial surface using a deformable shell model and calculate ESV and EDV from voxel counts. 2DE and RT3DE-derived volumes were compared with CMR (linear regression, Bland–Altman analysis). In most patients, analysis of RT3DE data required <2 min per patient. RT3DE measurements correlated highly with CMR (r: 0.96, 0.97, and 0.93 for EDV, ESV, and EF, respectively) with small biases (–14 mL, –6.5 mL, –1%) and narrow limits of agreement (SD: 17 mL, 16 mL, 6.4%). 2DE measurements correlated less well with CMR (r: 0.89, 0.92, 0.86) with greater biases (–23 mL, –15 mL, 1%) and wider limits of agreement (SD: 29 mL, 24 mL, 9.5%). RT3DE resulted in lower intra-observer (EDV: 7.9 vs. 23%; ESV: 7.6 vs. 26%) and inter-observer variability (EDV: 11 vs. 26%; ESV: 13 vs. 31%).

Conclusion Semi-automated detection of the LV endocardial surface from RT3DE data is suitable for clinical use because it allows rapid, accurate, and reproducible measurements of LV volumes, superior to conventional 2DE methods.

Key Words: Echocardiography • Magnetic resonance • Ventricular function • Ejection fraction


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