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Updated: Mar 8, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Three-dimensional echocardiographic quantification of the left-heart chambers using an automated adaptive analytics
Diego Medvedofsky1, Victor Mor-Avi1, Mihaela Amzulescu2
1University of Chicago, Medical Center, Chicago, Illinois, USA.
Insights
Automated three-dimensional echocardiography (3DE) accurately quantifies left heart chambers, offering a reproducible alternative to manual analysis. This advancement facilitates the integration of 3DE into routine clinical practice.
Area of Science:
- Cardiovascular Imaging
- Echocardiography
- Medical Technology
Background:
- Current guidelines recommend three-dimensional echocardiography (3DE) for chamber quantification.
- Clinical adoption of 3DE has been limited due to time-consuming manual analysis.
- An automated algorithm for measuring left atrial (LA) and left ventricular (LV) volumes and ejection fraction (EF) has been developed.
Purpose of the Study:
- To evaluate the accuracy and reproducibility of an automated 3DE chamber quantification algorithm.
- To assess the performance of the automated method in a multicentre setting.
Main Methods:
- 180 patients underwent 3DE imaging across six clinical sites.
- Images were analyzed using automated HeartModel (HM) software and manual tracing.
- Measurements were compared between automated HM (with and without corrections) and manual Core Laboratory (CL) analysis.
Main Results:
- Automated HM showed strong correlations with manual CL measurements for LV volumes (LVEDV, LVESV), LVEF, and LA volume (LAV).
- The automated technique demonstrated slight underestimations in LV volumes, LVEF, and LAV compared to manual tracing.
- Automated measurements with corrections were more reproducible than manual measurements and showed improved accuracy.
Conclusions:
- Automated 3DE analysis provides an accurate and reproducible alternative to conventional manual quantification of left heart chambers.
- The consistency of automated measurements across laboratories supports its clinical utility.
- This automated technique has the potential to facilitate the widespread integration of 3DE into routine clinical practice.
Aims:
Although recommended by current guidelines, adoption of three-dimensional echocardiographic (3DE) chamber quantification in clinical practice has lagged because of time-consuming analysis. We recently validated an automated algorithm that measures left atrial (LA) and left ventricular (LV) volumes and ejection fraction (EF). This study aimed to determine the accuracy and reproducibility of these measurements in a multicentre setting.
Methods And Results:
180 patients underwent 3DE imaging (Philips) at six sites. Images were analysed using automated HeartModel (HM) software with endocardial border correction when necessary and by manual tracing. Measurements were performed by each site and by the Core Laboratory (CL) as the reference. Inter-technique comparisons included HM measurements by the sites against manual tracing by CL, and showed strong correlations (r-values: LVEDV: 0.97, LVESV: 0.97, LVEF: 0.88, LAV: 0.96), with the automated technique slightly underestimating LV volumes (biases: LVEDV: -14 ± 20 ml, LVESV: -6 ± 20 ml), LVEF (-2 ± 7%) and LAV (-9 ± 10 ml). Intra-technique comparisons included HM measurements by the sites against CL, with and without corrections. Corrections were unnecessary or minimal in most patients, and improved the measurements only modestly. Comparisons without corrections showed perfect agreement for all parameters. With corrections, correlations were better (r-values: LVEDV: 0.99, LVESV: 0.99, LVEF: 0.94, LAV: 0.99) and biases (LVEDV: -8 ± 12 ml, LVESV: -6 ± 12 ml, LVEF: 1 ± 5%, LAV: -10 ± 6 ml) smaller than in inter-technique comparison. All automated measurements with corrections were more reproducible than manual measurements.
Conclusion:
Automated 3DE analysis of left-heart chambers is an accurate alternative to conventional manual methodology, which yields almost the same values across laboratories and is more reproducible. This technique may contribute towards full integration of 3DE quantification into clinical routine.
