European Heart Journal Advance Access originally published online on May 29, 2009
European Heart Journal 2009 30(13):1565-1573; doi:10.1093/eurheartj/ehp187
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Quantification of left ventricular volumes using three-dimensional echocardiographic speckle tracking: comparison with MRI
1 Public Hospital Elisabethinen, Linz, Austria
2 University of Chicago, MC5084, 5841 S. Maryland Ave., Chicago, IL 60637, USA
3 Toshiba Medical Systems, Zoetermeer, the Netherlands
Received 25 November 2008; revised 6 March 2009; accepted 21 April 2009; online publish-ahead-of-print 29 May 2009.
* Corresponding author. Tel: +1 773 702 1842, Fax: +1 773 702 1034, Email: rlang{at}bsd.uchicago.edu
See page 1554 for the editorial comment on this article (doi:10.1093/eurheartj/ehp218)
Aims: Although the utility of two-dimensional (2D) speckle tracking echocardiography (STE) to quantify left ventricular (LV) volume has been demonstrated, this methodology is limited by foreshortened views, geometric modelling, and the assumption that speckles can be tracked from frame to frame, despite their out of plane motion. To circumvent these limitations, a three-dimensional (3D) speckle tracking algorithm was recently developed. Our goal was to evaluate the accuracy of the new 3D-STE side by side with 2D-STE using cardiac magnetic resonance (CMR) as a reference.
Methods and results: Apical two- and four-chamber views (A2C and A4C) and real-time 3D datasets (Toshiba Artida 4D System) obtained in 43 patients with a wide range of LV size and function were analysed to measure LV end-systolic and end-diastolic volumes (ESV and EDV) using 2D and 3D-STE techniques. Short-axis CMR images (Siemens 1.5T scanner) acquired on the same day were analysed to obtain ESV and EDV reference values using the method of disks approximation. Reproducibility of both STE techniques was assessed using repeated measurements. While 2D-STE correlated well with CMR (r: 0.72–0.88), it underestimated LV volumes with relatively large biases (10–30 mL) and wide limits of agreement (SD: 36–51 mL), with A2C-derived measurements being worse than A4C values. The 3D-STE measurements showed higher correlation with CMR (0.87–0.92), and importantly smaller biases (1–16 mL) and narrower limits of agreement (SD: 28–37 mL). In addition, 3D-STE showed lower inter- and intra-observer variability (11–14% and 12–13%), than 2D-STE (16–17% and 12–16%, respectively).
Conclusion: This is the first study to validate the new 3D-STE technique for LV volume measurements and demonstrate its superior accuracy and reproducibility over previously used 2D-STE technique.
Key Words: Echocardiography • Magnetic resonance imaging • Left ventricle
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- Towards assessment of left ventricular mechanics in true three dimensions
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EHJ 2009 30: 1554-1555.[Extract] [Full Text]
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  W.-J. Flu, J.-P. van Kuijk, J. J. Bax, J. Gorcsan III, and D. Poldermans Three-dimensional speckle tracking echocardiography: a novel approach in the assessment of left ventricular volume and function? Eur. Heart J., October 1, 2009; 30(19): 2304 - 2307. [Full Text] [PDF]
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V. Delgado, J. J. Bax, and E. E. van der Wall Towards assessment of left ventricular mechanics in true three dimensions Eur. Heart J., July 1, 2009; 30(13): 1554 - 1555. [Full Text] [PDF]
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