Related Experiment Video
Updated: May 27, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Sources of variation and bias in assessing left ventricular volumes and dyssynchrony using three-dimensional
Denisa Muraru1, Luigi P Badano, Davide Ermacora
1Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Centro Gallucci, Via Giustiniani 2, 35128 Padua, Italy. denisa.muraru@gmail.com
Insights
Manual editing, software sensitivity, and image quality significantly affect 3D echocardiography measurements of left ventricular (LV) volumes and dyssynchrony. Optimizing these factors is crucial for accurate LV assessment using 3DE.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- 3D echocardiography (3DE) is a valuable tool for assessing left ventricular (LV) function.
- Variability in 3DE measurements can impact clinical decision-making.
- Understanding sources of variability is essential for improving accuracy.
Purpose of the Study:
- To investigate factors influencing the measurement variability of LV volumes and dyssynchrony using 3DE.
- To assess the impact of manual editing, temporal resolution, segmentation models, software sensitivity, and image quality on 3DE parameters.
Main Methods:
- 100 patients were studied to evaluate the effects of manual editing, data set temporal resolution, LV segmentation models (16- vs. 17-segment), software sensitivity for endocardial detection, and image quality.
- Measurements included LV end-diastolic (EDV) and end-systolic (ESV) volumes, sphericity indices, ejection fraction (EF), and dyssynchrony index (SDI).
- Cardiac magnetic resonance (CMR) served as the reference standard in 26 patients.
Main Results:
- Manual editing improved LV volume agreement with CMR but increased SDI.
- Data set temporal resolution and the 17th LV segment did not significantly impact SDI.
- Reduced software sensitivity improved agreement with CMR for EDV and ESV, and decreased SDI.
- The impact of software sensitivity on LV parameters was influenced by image quality, affecting SDI and volumes differently in suboptimal vs. optimal quality images.
Conclusions:
- Manual editing, software settings, and image quality are significant determinants of variability in 3D LV volume and dyssynchrony assessment.
- Careful consideration of these factors is necessary for reliable and reproducible 3DE analysis.
Abstract:
Study aim To explore various sources of variability in the measurement of LV volumes and dyssynchrony by 3D echocardiography (3DE). Methods We studied 100 patients (58 ± 18 years, 51 men) to assess the impact of: (1) manual editing; (2) 3D data set temporal resolution; (3) LV 16- or 17-segmentation model; (4) software sensitivity for automated endocardial surface detection; and (5) image quality, on the measurement of LV end-diastolic (EDV) and end-systolic (ESV) volumes, sphericity indices (EDSI, ESSI), ejection fraction (EF) and dyssynchrony (SDI). Two- and 4-beat LV full-volume data sets were analyzed and compared. Cardiac magnetic resonance (CMR) was used as reference in 26 patients. Results Manual editing of endocardial surface improved the agreement of LV volumes with CMR, but increased SDI (SDI17: 5.6 ± 0.5% vs. 4.3 ± 0.3%; P < 0.0001). Data set temporal resolution had no significant impact on LV parameters. Adding the 17th to 16-segment LV model did not significantly increase SDI. Reducing software sensitivity in endocardial surface detection increased EDV (101 ± 46 ml vs. 118 ± 50 ml) and sphericity, decreased SDI (SDI 17: 6.7 ± 3.3% vs. 2.9 ± 3.7%) (P < 0.05 for all), and improved agreement of EDV and ESV with CMR. Impact of software sensitivity in LV endocardium detection on LV parameters was related to image quality: higher on SDI in pts with suboptimal quality (SDI 17 bias 4.5% vs. 3.2%, P < 0.05); higher on LV volumes in patients with optimal quality (EDV bias 14 ml vs. 19 ml, ESV bias 5 ml vs. 9 ml; P = 0.01). Conclusions Manual editing, software settings and image quality significantly impact on 3D LV volumes and dyssynchrony assessment.
