Related Experiment Video
Updated: Jul 5, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
How accurately, reproducibly, and efficiently can we measure left ventricular indices using M-mode, 2-dimensional,
Xiuzhang Lu1, Mingxing Xie, David Tomberlin
1The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.
Insights
Three-dimensional echocardiography (3DE) offers superior accuracy and reproducibility for measuring left ventricular (LV) indices in children compared to M-mode (MM) and 2D methods. Automated 3DE is recommended for precise LV quantification.
Area of Science:
- Pediatric Cardiology
- Medical Imaging
- Echocardiography
Background:
- Left ventricular (LV) assessment is crucial in pediatric heart disease.
- Limited comparative data exist for M-mode (MM), 2D, and 3D echocardiography (3DE) in LV index quantification.
- Accurate LV measurements are vital for clinical practice and research in children.
Purpose of the Study:
- To compare the accuracy, reproducibility, and efficiency of MM, 2D, and 3DE for LV index measurements in children.
- To evaluate different 3DE analysis algorithms (manual and automated).
- To establish the optimal echocardiographic method for LV quantification in pediatric patients.
Main Methods:
- Prospective study of 20 children using M-mode, 2D, and real-time 3D echocardiography (RT3DE).
- LV indices measured according to American Society of Echocardiography guidelines.
- Comparison with magnetic resonance imaging (MRI) using disk summation method.
Main Results:
- All methods showed good correlation (r=0.81-0.97) with MRI; RT3DE demonstrated superior correlation.
- Intra- and interobserver variability was lowest for 3DE (0.4%-4.8%), followed by 2DE, then MM.
- MM was fastest, but 3DE with automated algorithms was as efficient as 2DE and more accurate.
Conclusions:
- M-mode echocardiography is efficient but least accurate and reproducible for LV indices.
- 3DE, particularly with automated algorithms, surpasses MM and 2DE in accuracy and reproducibility.
- Automated 3DE is the preferred method for quantifying LV indices in children due to its accuracy, reproducibility, and efficiency.
Background:
Measurements of left ventricular (LV) size, mass, and function are the most common and important tasks for echocardiography in clinical practice and research in children with congenital and acquired heart diseases. There are little data to compare the utility of M-mode (MM), 2-dimensional (2D), and 3-dimensional (3D) echocardiographic techniques for quantification of LV indices. The objective of the study was to assess the accuracy, reproducibility, and efficiency of these echocardiographic methods for measurement of LV indices in children.
Methods:
A prospective study was conducted in 20 consecutive children (mean 10.6 +/- 2.8 years, 11 male and 9 female subjects) using conventional MM, 2D, and real-time 3D echocardiography (RT3DE). A Sonos 7500 system (Philips Medical Systems, Andover, MA) was used. M-mode and 2DE measurements were made according to the American Society of echocardiography recommendations. To include the entire LV for volumetric measurement, full-volume 3D data sets were acquired from 4 electrocardiogram gated subvolumes. The 3DE measurements were made off-line manually using 4-plane and 8-plane algorithms by 4D Echo-View (TomTec Imaging Systems, Munich, Germany) and a semiautomated algorithm by QLAB (Philips Medical Systems). Magnetic resonance imaging studies were also performed to determine the LV indices by a disk summation method based on the Simpson principle.
Results:
The correlation and agreement between MM, 2D, and RT3D echocardiography and magnetic resonance imaging measurements are good (r = 0.81-0.97) for the 3 methods. The correlation was superior for RT3DE compared with 2DE and MM. The correlation and agreement were similar for the three 3DE methods. The intra- and interobserver variabilities ranged from MM (4.3%-4.8% and 7.0%-8.7%), 2DE (3.3%-4.5% and 5.5%-7.3%), and 3DE (0.4%-2.3%, and 0.2%-4.8%). The total time (acquisition and analysis) used for MM measurements was the least compared with 2DE and 3DE. The total time for 3DE using the semiautomated algorithms was not significantly different compared with that for 2DE.
Conclusions:
Our study showed that MM provides the most efficient assessment of LV indices but is the least accurate and reproducible technique compared with 2DE and 3DE. Three-dimensional echocardiography using both automated and manual analysis algorithm is superior to MM and 2DE for measurements of LV indices, and the automated 3DE algorithm is as efficient as 2DE. Therefore, 3DE using the automated algorithm is the method of choice for quantification of LV indices.
