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Updated: Jun 8, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Three-dimensional echocardiography using single-heartbeat modality decreases variability in measuring left
Kambiz Shahgaldi1, Aristomenis Manouras, Anna Abrahamsson
1Department of Cardiology, Karolinska University Hospital Huddinge, Stockholm, Sweden. kambiz.shahgaldi@karolinska.se
Insights
Single-beat 3D echocardiography significantly reduces variability in measuring left ventricular volumes and ejection fraction for patients with atrial fibrillation compared to four-beat methods.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Three-dimensional echocardiography (3DE) offers accuracy comparable to cardiac magnetic resonance for left ventricular (LV) volume and ejection fraction (EF) assessment.
- Multibeat 3DE necessitates breath-holding and regular heart rhythm, posing challenges for patients with atrial fibrillation (AF) due to potential stitching artifacts.
- Single-beat (SB) 3DE acquisition may overcome limitations of multibeat techniques in AF patients.
Purpose of the Study:
- To evaluate if SB full volume 3DE acquisition reduces inter- and intraobserver variability in LV volume and EF assessment.
- To compare SB 3DE with four-beat (4B) ECG-gated 3DE in patients with AF.
Main Methods:
- A total of 78 patients were studied: 55 in sinus rhythm (group A) and 23 with AF (group B).
- Both 4B and SB 3DE were performed on all participants.
- Inter- and intraobserver variability for LV volumes and EF measurements were analyzed for both modalities.
Main Results:
- SB modality demonstrated significantly lower inter- and intraobserver variability in group B (AF patients) compared to 4B for LV volumes and EF, excluding end-systolic volume (ESV) in intraobserver analysis.
- Significant differences were observed in LV volume (p < 0.001) and EF (p < 0.05) calculations using SB versus 4B in group B.
Conclusions:
- SB 3DE appears superior to 4B ECG-gated acquisition for measuring LV volumes and EF in patients with AF.
- SB 3DE significantly reduces variability in both EF and LV volume measurements in this patient cohort.
Background:
Three dimensional echocardiography (3DE) approaches the accuracy of cardiac magnetic resonance in measuring left ventricular (LV) volumes and ejection fraction (EF). The multibeat modality in comparison to single-beat (SB) requires breath-hold technique and regular heart rhythm which could limit the use of this technique in patients with atrial fibrillation (AF) due to stitching artifact. The study aimed to investigate whether SB full volume 3DE acquisition reduces inter- and intraobserver variability in assessment of LV volumes and EF in comparison to four-beat (4B) ECG-gated full volume 3DE recording in patients with AF.
Methods:
A total of 78 patients were included in this study. Fifty-five with sinus rhythm (group A) and 23 having AF (group B). 4B and SB 3DE was performed in all patients. LV volumes and EF was determined by these two modalities and inter- and intraobserver variability was analyzed.
Results:
SB modality showed significantly lower inter- and intraobserver variability in group B in comparison to 4B when measuring LV volumes and EF, except for end-systolic volume (ESV) in intraobserver analysis. There were significant differences when calculating the LV volumes (p < 0.001) and EF (p < 0.05) with SB in comparison to 4B in group B.
Conclusion:
Single-beat three-dimensional full volume acquisition seems to be superior to four-beat ECG-gated acquisition in measuring left ventricular volumes and ejection fraction in patients having atrial fibrillation. The variability is significantly lower both for ejection fraction and left ventricular volumes.
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