Related Experiment Videos
Assessment of cardiac function by three-dimensional echocardiography compared with conventional noninvasive methods
1Columbia University College of Physicians and Surgeons, Division of Cardiology, New York, NY, USA.
Insights
Three-dimensional echocardiography (3DE) provides accurate left ventricular ejection fraction (LVEF) measurements, comparable to equilibrium radionuclide angiography. This advanced 3DE method offers superior precision over traditional 2D echocardiography for serial cardiac function assessment.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Accurate, noninvasive serial quantification of left ventricular ejection fraction (LVEF) is crucial for managing heart disease patients.
- Equilibrium radionuclide angiography (ERNA) is a standard but has limitations.
- Echocardiography offers advantages like portability and lower cost but conventional methods suffer from geometric assumptions and subjective analysis.
Purpose of the Study:
- To develop and evaluate a novel three-dimensional echocardiography (3DE) method for LVEF determination.
- To compare the accuracy and reliability of 3DE against ERNA and conventional 2D echocardiographic techniques.
Main Methods:
- Fifty-one patients with suspected heart disease underwent LVEF assessment using ERNA and 3DE.
- 3DE utilized an interactive line-of-intersection display and a ventricular surface reconstruction algorithm.
- Conventional methods included quantitative 2D echocardiography (apical biplane summation-of-disks) and subjective visual estimation.
Main Results:
- 3DE demonstrated excellent correlation with ERNA for LVEF (r = .94–.97), with low standard error of the estimate (SEE) and narrow limits of agreement.
- 3DE showed twofold to threefold lower SEE and limits of agreement compared to all 2D echocardiographic techniques.
- Interobserver variability was significantly lower for 3DE (10.2%) versus 2D methods (26.1% quantitative, 33.3% visual).
Conclusions:
- 3DE provides LVEF determination results comparable to ERNA.
- 3DE significantly outperforms conventional 2D echocardiographic methods in accuracy and reproducibility.
- 3DE is a viable alternative for accurate serial quantification of left ventricular function.
Background:
Reliable, serial, noninvasive quantitative estimation of left ventricular ejection fraction is essential for selecting and timing therapeutic interventions in patients with heart disease. Equilibrium radionuclide angiography is widely used for this purpose but has well-recognized limitations. Advantages of echocardiography over equilibrium radionuclide angiography include assessment of wall motion, valvular pathology, and cardiac hemodynamics, in addition to portability, lack of radiation exposure, and substantially lower cost. However, conventional echocardiographic techniques are limited by geometric assumptions, image positioning errors, and use of subjective visual methods. To overcome these limitations, a three-dimensional echocardiographic method was developed. This study compares ejection fraction by three-dimensional echocardiography, quantitative two-dimensional echocardiography, and subjective two-dimensional echocardiographic visual estimation with that by equilibrium radionuclide angiography.
Methods And Results:
Fifty-one unselected patients with suspected heart disease underwent left ventricular ejection fraction determination by equilibrium radionuclide angiography and three-dimensional echocardiography using an interactive line-of-intersection display and a new algorithm, ventricular surface reconstruction, for volume computation. In 44 patients, ejection fractions were also estimated visually by experienced observers from two-dimensional echocardiography and by quantitative two-dimensional echocardiography using an apical biplane summation-of-disks algorithm. An excellent correlation was obtained between three-dimensional echocardiography and equilibrium radionuclide angiography (r = .94 to .97, SEE = 3.64% to 5.35%; limits of agreement, 10.3% to 13.3%) without significant underestimation or overestimation. SEE values and limits of agreement were twofold to threefold lower than corresponding values for all two-dimensional echocardiographic techniques. In addition, interobserver variability was significantly lower for the three-dimensional echocardiographic method (10.2%) than for the apical biplane summation-of-disks method (26.1%) and subjective visual estimation (33.3%).
Conclusions:
Determination of ejection fraction by three-dimensional echocardiography yields results comparable to those obtained by equilibrium radionuclide angiography and is substantially superior to all two-dimensional echocardiographic methods. Therefore, three-dimensional echocardiography may be used for accurate serial quantification of left ventricular function as an alternative to equilibrium radionuclide angiography.