Bias associated with left ventricular quantification by multimodality imaging: a systematic review and meta-analysis

Area of Science:

• Cardiovascular Imaging
• Medical Diagnostics
• Radiology

Background:

• Cardiac Magnetic Resonance (CMR) is the gold standard for left ventricular (LV) quantification.
• Two-dimensional echocardiography (2DE) is widely used, but its accuracy compared to CMR is debated.
• Three-dimensional echocardiography (3DE) and multidetector CT (MDCT) are emerging modalities for LV assessment.

Purpose of the Study:

• To systematically review and evaluate the accuracy and bias of non-invasive imaging modalities for LV quantification compared to CMR.
• To assess the interchangeability of 2DE, contrast-enhanced 2DE (CE-2DE), 3DE, and MDCT against CMR.
• To determine the most accurate modality for LV volume and ejection fraction estimation.

Main Methods:

• Systematic review of studies comparing LV quantification by 2DE, CE-2DE, 3DE, and MDCT with CMR.
• Inclusion of studies using modern CMR (SSFP sequences) and excluding small sample sizes or congenital heart diseases.
• Evaluation of LV end-diastolic volume (LVEDV), end-systolic volume (LVESV), and ejection fraction (LVEF).

Main Results:

• 65 studies (2888 patients) were included, comparing 4032 scans.
• 2DE significantly underestimated LV volumes (LVEDV -33.30 mL, LVESV -16.20 mL).
• 3DE and CE-2DE also underestimated LV volumes, though to a lesser extent.
• MDCT showed excellent agreement with CMR for LV volumes (LVEDV -1.20 mL).
• Excellent agreement was observed for LVEF estimation across echocardiographic methods, particularly with 3DE (LVEF 0.14%).

Conclusions:

• MDCT demonstrates excellent accuracy for LV volume quantification, comparable to CMR.
• 3DE offers the highest accuracy for LVEF estimation among echocardiographic techniques.
• While 2DE and 3DE underestimate LV volumes, MDCT provides reliable volumetric data.