Intraoperative three-dimensional versus two-dimensional echocardiography for left ventricular assessment

Area of Science:

• Cardiology
• Medical Imaging
• Echocardiography

Background:

• Three-dimensional transesophageal echocardiography (3D TEE) is increasingly utilized in intraoperative cardiac surgery.
• 3D TEE demonstrates better correlation with cardiac magnetic resonance imaging for left ventricular (LV) measurements than 2D transthoracic echocardiography.

Purpose of the Study:

• To compare intraoperative 3D TEE with conventional 2D TEE for quantitative assessment of LV function.

Main Methods:

• 156 patients undergoing elective cardiac surgery had both 2D TEE and 3D TEE performed.
• LV volumes and ejection fraction (EF) were calculated using standard methods for both techniques.
• Quantitative indices, image quality, acquisition/analysis times, and reproducibility were compared using statistical tests and Bland-Altman analysis.

Main Results:

• No significant difference was found in LV ejection fraction (EF) estimation between 3D and 2D TEE (P = 0.227).
• 3D TEE calculated larger indexed LV end-diastolic and end-systolic volumes (P < 0.001), but this did not alter clinical classification in most cases (98.8% for iEDV, 92.8% for iESV).
• Image quality and acquisition time were similar, but 3D TEE analysis required significantly more time (P < 0.001). Reproducibility was comparable for both methods.

Conclusions:

• Intraoperative 3D TEE provides comparable LV global function quantification, acquisition time, and reproducibility to 2D TEE.
• Despite calculating larger LV volumes, 3D TEE measurements do not affect the clinical classification of LV dilation.
• 3D TEE is a viable alternative for intraoperative LV assessment, though analysis time is longer.