Original article
Real-Time Transthoracic Three-Dimensional Echocardiographic Assessment of Left Ventricular Volume and Ejection Fraction in Congenital Heart Disease

https://doi.org/10.1016/j.echo.2005.06.009Get rights and content

Objective

The purpose of this study was to assess the (1) feasibility of real-time three-dimensional echocardiography (RT-3DE) data acquisition and (2) volumes and function of the abnormal left ventricle (LV) in adult patients with congenital heart disease (CHD), compared with magnetic resonance imaging (MRI) data.

Methods

Thirty-two patients (59% were male) with CHD were evaluated on the same day by MRI and RT-3DE. Acquisition of RT-3DE data sets was feasible in 29 of the 32 patients (91%). The time of 3D data acquisition was 4 ± 2 minutes, and LV analysis was 17 ± 5 minutes per patient for manual border tracing.

Results

A good correlation was observed between RT-3DE with manual border detection and MRI for LV end-diastolic volume (r = 0.97), LV end-systolic volume (r = 0.98), and LV ejection fraction (r = 0.94).

Conclusion

RT-3DE is feasible for volumetric analysis of the abnormal LV allowing accurate determination of LV volume and ejection fraction compared with MRI in adult patients with CHD.

Section snippets

Study Population

Thirty-two consecutive patients (59% were male) who were scheduled for routine MRI examination were included in the study. The mean age was 31 ± 9 years (range 19-51 years). All patients had distorted LV geometry that originated from the congenital heart malformation itself and was the result of a dilated or high-pressured right ventricle. In 13 patients with surgically corrected tetralogy of Fallot, LV geometry was abnormal throughout the cardiac cycle because of flattening of the

Results

Acquisition of RT-3DE data sets was feasible in 29 of the 32 patients (91%). One patient had poor acoustic windows because of severe obesity, and two patients had persistent respiratory artifacts that precluded adequate 3D rendering. MRI was feasible in 29 patients; three patients (not the same patients in which RT-3DE was not successful) had claustrophobia or artifacts that prohibited complete analysis. The mean heart rate was 68 ± 8 beats/min during echocardiographic examination and 66 ± 9

Discussion

The results of this study indicate that RT-3DE data acquisition of the abnormally shaped LV for volumetric analysis is feasible in patients with CHD. There is a good agreement between RT-3DE using manual border tracing and MRI for the assessment of LV volume and function. Furthermore, the intraobserver and interobserver variabilities were limited. This implies that this technique is largely operator-independent and can be used in clinical practice.

Until now, 3D echocardiography was hampered by

Study limitations

To acquire a full-volume data set, four high-resolution subvolumes need to be acquired over consecutive heartbeats in a short breath-hold. Patients with arrhythmia or severe dyspnea, who are incapable of breath-holding, cannot be investigated using this technique. However, this also applies for MRI.

The RT-3DE system has a limited angle for full volume acquisition; this may cause inaccurate measurements of LV volume when the entire LV cannot be included in the pyramidal volume.

This study was

Conclusion

RT-3DE is feasible in adult patients with CHD for volumetric analysis of the abnormal LV and allows accurate determination of its volume and EF compared with MRI. RT-3DE may potentially provide convenient, mobile, and comprehensive evaluation of LV function in patients with CHD.

References (23)

Cited by (78)

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