European Heart Journal Advance Access originally published online on November 8, 2008
European Heart Journal 2009 30(1):98-106; doi:10.1093/eurheartj/ehn484
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Left ventricular volume measurement with echocardiography: a comparison of left ventricular opacification, three-dimensional echocardiography, or both with magnetic resonance imaging
Department of Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane Q4102, Australia
Received 15 May 2008; revised 21 September 2008; accepted 9 October 2008; online publish-ahead-of-print 8 November 2008.
* Corresponding author. Tel: +61 7 3240 5340, Fax: +61 7 3240 5399, Email: t.marwick{at}uq.edu.au
Aims: Both contrast enhanced (CE) two-dimensional echocardiography (2DE) and three-dimensional echocardiography (3DE) have been proposed as techniques to improve the accuracy of left ventricular (LV) volume measurements. We sought to examine the accuracy of non-contrast (NC) and CE-2DE and 3DE for calculation of LV volumes and ejection fraction (EF), relative to cardiac magnetic resonance imaging (MRI).
Methods and results: We studied 50 patients (46 men, age 63 ± 10 year) with past myocardial infarction who underwent echocardiographic assessment of LV volume and function. All patients sequentially underwent NC-2DE followed by NC-3DE. CE-2DE and CE-3DE were acquired during contrast infusion. Resting echocardiographic image quality was evaluated on the basis of NC-2DE. The mean LV end-diastolic volume (LVEDV) of the group by MRI was 207 ± 79 mL and was underestimated by 2DE (125 ± 54 mL, P = 0.005), and less by CE-2DE (172 ± 58 mL, P = 0.02) or 3DE (177 ± 64 mL, P = 0.08), but EDV was comparable by CE-3DE (196 ± 69 mL, P = 0.16). Limits of agreement with MRI were similar for NC-3DE and CE-2DE, with the best results for CE-3D. Results were similar for calculation of LVESV. Patients were categorized into groups of EF (
35, 35–50, >50%) by MRI. NC-2DE demonstrated a 68% agreement (kappa 0.45, P = 0.001), CE-2DE a 62% agreement (kappa 0.20, P = 136), NC-3DE a 74% agreement (kappa 0.39, P = 0.005) and CE-3DE an 80% agreement (kappa 0.56, P < 0.001).
Conclusion: CE-2DE is analogous to NC-3DE in accurate categorization of LV function. However, CE-3DE is feasible and superior to other NC- and CE-techniques in patients with previous infarction.
Key Words: Contrast-enhancement • Left ventricular volumes • Two-dimensional echocardiography • Three-dimensional echocardiography
Joint first authors.