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Updated: Jul 6, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Variability and resource utilization of bedside three-dimensional echocardiographic quantitative measurements of left
George Baker1, English Flack, Anthony Hlavacek
1Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA. baker@ musc.edu
Insights
Bedside 3-dimensional echocardiographic left ventricular volume analysis (3D-LVVA) demonstrates high reproducibility in congenital heart disease (CHD) patients. This technique is suitable for routine clinical use in CHD care.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Limited data exists on the resource utilization and variability of 3D-LVVA in congenital heart disease (CHD).
- Assessing left ventricular volumes is crucial for managing CHD patients.
Purpose of the Study:
- To evaluate the variability and time resource utilization of bedside 3D-LVVA in CHD.
- To determine the inter- and intraobserver reproducibility of 3D-LVVA for key volumetric parameters.
Main Methods:
- Four reviewers of varying experience performed 15 on-scanner 3D-LVVAs.
- Inter- and intraobserver variability for LVEDV, LVESV, and LVEF were assessed using ICCs and Bland-Altman analysis.
Main Results:
- High interobserver reproducibility was observed for LVEDV (ICC 0.991-0.999), LVESV (ICC 0.98-0.99), and LVEF (ICC 0.95-0.98).
- Intraobserver reproducibility was also high, with ICCs of 0.99 for LVEDV and LVESV, and 0.94 for LVEF.
- Variability was not significantly dependent on ventricular volumes or heart rate.
Conclusions:
- Bedside 3D-LVVA can be performed by reviewers with varying experience levels.
- The technique shows acceptable inter- and intraobserver reproducibility in CHD patients.
- These findings support the integration of 3D-LVVA into routine CHD patient care.
Objectives:
This study evaluated the variability and time resource utilization of bedside 3-dimensional echocardiographic left ventricular volume analysis (3D-LVVA) in congenital heart disease (CHD). Background. There are currently limited data on the resource utilization and variability of 3D-LVVA in the CHD.
Methods:
Four reviewers of varying experience levels were timed performing 15 on-scanner 3D-LVVAs. Inter- and intraobserver variability for left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), and ejection fraction (LVEF) was evaluated.
Results:
Median age was 12.7 years (0.6-33 years). Diagnoses were: normal (n = 4), cardiomyopathy (n = 4), ventricular septal defect (n = 2), and atrioventricular canal, tricuspid atresia, bicuspid aortic valve, left ventricular hypertrophy, and heart transplant (n = 1 each). For interobserver variability, intraclass correlation coefficients (ICCs) for all possible combinations of reviewers were: LVEDV, 0.991-0.999 (P < .01); LVESV, 0.98-0.99 (P < .01); LVEF, 0.95-0.98 (P < .01). Bland-Altman plot mean differences (+/-2SD) were: LVEDV, -3 +/- 14%; LVESV, -5.4 +/- 21.4%; LVEF, 1.2 +/- 14.7%. Interobserver variability of LVESV was not dependent on ventricular volumes (P = .25; r(2) = 0.01) or heart rate (P = .43; r(2) = 0.003). For intraobserver variability, ICCs for 2 reviewers were LVEDV, 0.99, 0.99 (P < .01); LVESV, 0.99, 0.99 (P < .01); and LVEF, 0.94, 0.94 (P < .01), respectively. Bland-Altman plot mean differences (+/-2SD) were: LVEDV, -1 +/- 9.2%; LVESV, 0 +/- 19.6%; LVEF, -2.2 +/- 24%.
Conclusion:
Reviewers with varying experience levels can accomplish 3D-LVVA at the bedside with acceptable inter- and intraobserver reproducibility, providing the rationale for integrating 3D-LVVA into the care of CHD patients.
