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Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
06:34

Evaluation of Left Ventricular Structure and Function using 3D Echocardiography

Published on: October 28, 2020

Real-time 3-dimensional echocardiographic assessment of left ventricular dyssynchrony: pitfalls in patients with

Carolin Sonne1, Lissa Sugeng, Masaaki Takeuchi

  • 1University of Chicago Medical Center, Chicago, Illinois 60637, USA.

JACC. Cardiovascular Imaging
|July 18, 2009
PubMed

Insights

Real-time 3-dimensional echocardiography (RT3DE) derived left ventricular (LV) dyssynchrony index (LVDI) values are age-dependent and differ between normal subjects and dilated cardiomyopathy (DCM) patients. Current RT3DE-LVDI assessment needs critical reassessment for patients with reduced LV function.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Echocardiography

Background:

  • Cardiac resynchronization therapy (CRT) is ineffective in a significant portion of heart failure patients.
  • There is a need for improved methods to assess left ventricular (LV) dyssynchrony.
  • Real-time 3-dimensional echocardiography (RT3DE) offers potential for LV dyssynchrony assessment.

Purpose of the Study:

  • Establish normal values for RT3DE-derived LV dyssynchrony index (LVDI).
  • Determine the age dependency of LVDI.
  • Compare LV dyssynchrony in patients with normal LV function and dilated cardiomyopathy (DCM), with and without left bundle branch block (LBBB).

Main Methods:

  • RT3DE datasets were analyzed to calculate LVDI using 16- and 17-segment models.
  • 135 normal subjects were studied to establish LVDI abnormality thresholds and age-related changes.
  • Three patient groups (DCM with/without LBBB, normal LV function with LBBB) were compared to age-matched controls.

Main Results:

  • The 16-segment model yielded a lower LVDI abnormality threshold than the 17-segment model (4.0% vs. 4.5%).
  • LVDI was significantly lower in patients with normal LV function compared to DCM patients, regardless of LBBB.
  • LBBB increased LVDI in normal LV function but not in DCM; all DCM patients with ejection fraction <35% had abnormally high LVDI.

Conclusions:

  • Established normal LVDI values led to indiscriminate diagnosis of abnormal dyssynchrony in patients with reduced LV function.
  • RT3DE-derived LVDI's utility in evaluating dyssynchrony in reduced LV function requires reassessment due to end-ejection detection issues.
  • Development of alternative dyssynchrony indices is necessary to overcome current limitations.
Abstract

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