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Comparison of real time 3-dimensional echocardiography with cardiovascular magnetic resonance for left ventricular volumetric assessment - a real world study

Study objective

To assess the accuracy and reproducibility of real time 3-dimensional echocardiography (RT3DE) for left ventricular (LV) volumetric assessment in consecutive, unselected patients.

Introduction

The accuracy and reproducibility of RT3DE for LV volumetric assessment has been demonstrated in a number of clinical trials. We aimed to assess the 'real-world' accuracy and reproducibility of RT3DE in consecutive, unselected patients.

Methods

Sixty patients undergoing clinically indicated cardiac magnetic resonance imaging (CMR) also underwent RT3DE. CMR images were obtained using a 1.5 T scanner (Siemens Avanto, Germany) equipped with a 32-channel surface coil. RT3DE images were obtained using an IE33 scanner (Philips, USA). LV volumes and ejection fraction (EF) were measured by 2 independent observers for both modalities. RT3DE measurements were compared to those obtained by CMR. Inter-observer reproducibility was assessed, and 25% of scans were re-analysed to assess intra-observer reproducibility. RT3DE image quality was independently graded as good, adequate and non-analysable.

Results

Only 13 patients (22%) were deemed to have good RT3DE image quality by both observers. In these patients, RT3DE measurement of EF correlated highly with CMR (mean+standard deviation -2.0 + 4%, r = 0.97, Bland-Altman 95% levels of agreement (BA) -9 to 5%). LV volumes were underestimated by RT3DE (end diastolic volume (EDV) -26 + 23 mls, end systolic volume (ESV) -10 + 19 mls) in keeping with findings from other studies. Inter-observer reproducibility for measurement of EF was high (1.2+ 3%, r = 0.98, BA -5 to 7%); as was intra-observer reproducibility (0.1 + 2%, r = 0.99, BA -4 to 4%) (Table 1). 29 patients had adequate RT3DE image quality. In these patients, correlation of RT3DE and CMR measurement of EF was significantly lower (-0.5 + 9, r = 0.82, BA -19 to 18%). LV volumes were underestimated to a greater degree (EDV -39 + 31 mls, ESV -11 + 31 mls) and inter-observer (-1.2 + 6%, r = 0.84, BA -13 to 10%) and intra-observer reproducibility (0.5 + 4, r = 0.97, -7 to 8%) were also considerably lower (Table). RT3DE image quality was deemed non-analysable in 18 patients (30%), with inadequate visualisation of the anterior wall alone being responsible in 10 (56%).

Table 1 Table 1

Conclusion

In this real-world study, RT3DE LV volumetric assessment was comparable to CMR when RT3DE image quality was good. However, image quality was good in only 22% of patients. In the remaining 78%, image quality was such that RT3DE assessment was either not possible or accuracy and reproducibility were significantly lower. Because CMR can obtain good image quality in a greater proportion of patients, it remains the gold standard for LV volumetric assessment.

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Correspondence to Christopher A Miller.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Miller, C.A., Pearce, K.A., Jordan, P. et al. Comparison of real time 3-dimensional echocardiography with cardiovascular magnetic resonance for left ventricular volumetric assessment - a real world study. J Cardiovasc Magn Reson 12, P243 (2010). https://doi.org/10.1186/1532-429X-12-S1-P243

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Keywords

  • Image Quality
  • Ejection Fraction
  • Cardiovascular Magnetic Resonance
  • Cardiac Magnetic Resonance
  • Cardiac Magnetic Resonance Image