Clinical study
Validation of real-time three-dimensional echocardiography for quantifying left ventricular volumes in the presence of a left ventricular aneurysm: in vitro and in vivo studies

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Abstract

OBJECTIVES

To validate the accuracy of real-time three-dimensional echocardiography (RT3DE) for quantifying aneurysmal left ventricular (LV) volumes.

BACKGROUND

Conventional two-dimensional echocardiography (2DE) has limitations when applied for quantification of LV volumes in patients with LV aneurysms.

METHODS

Seven aneurysmal balloons, 15 sheep (5 with chronic LV aneurysms and 10 without LV aneurysms) during 60 different hemodynamic conditions and 29 patients (13 with chronic LV aneurysms and 16 with normal LV) underwent RT3DE and 2DE. Electromagnetic flow meters and magnetic resonance imaging (MRI) served as reference standards in the animals and in the patients, respectively. Rotated apical six-plane method with multiplanar Simpson’s rule and apical biplane Simpson’s rule were used to determine LV volumes by RT3DE and 2DE, respectively.

RESULTS

Both RT3DE and 2DE correlated well with actual volumes for aneurysmal balloons. However, a significantly smaller mean difference (MD) was found between RT3DE and actual volumes (−7 ml for RT3DE vs. 22 ml for 2DE, p = 0.0002). Excellent correlation and agreement between RT3DE and electromagnetic flow meters for LV stroke volumes for animals with aneurysms were observed, while 2DE showed lesser correlation and agreement (r = 0.97, MD = −1.0 ml vs. r = 0.76, MD = 4.4 ml). In patients with LV aneurysms, better correlation and agreement between RT3DE and MRI for LV volumes were obtained (r = 0.99, MD = −28 ml) than between 2DE and MRI (r = 0.91, MD = −49 ml).

CONCLUSIONS

For geometrically asymmetric LVs associated with ventricular aneurysms, RT3DE can accurately quantify LV volumes.

Abbreviations

2DE
two-dimensional echocardiography
EDV
end-diastolic volume
EF
ejection fraction
EM
electromagnetic flow meter
ESV
end-systolic volume
LV
left ventricle
MD
mean difference
MRI
magnetic resonance imaging
RT3DE
real-time three-dimensional echocardiography
SV
stroke volume

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This study was supported, in part, by grant NCC9-60, National Aeronautics and Space Administration, Houston, Texas, and grant #9951522v from the American Heart Association Ohio Local Chapter, Columbus, Ohio, and grant #ROI-HL 56688-01A1 from the National Institutes of Health, Bethesda, Maryland.