Methods
Measurements and day-to-day variabilities of left ventricular volumes and ejection fraction by three-dimensional echocardiography and comparison with magnetic resonance imaging

https://doi.org/10.1016/S0002-9149(98)00306-3Get rights and content

Abstract

The aim of this study was to assess day-to-day variability of left ventricular (LV) volume and ejection fraction (EF) calculated from 3-dimensional echocardiography (3-DE) and to compare the reproducibility of the measurement with magnetic resonance imaging. Forty-six subjects were examined including 15 normal volunteers (group A) and 31 patients with LV dysfunction (group B). Precordial 3-DE acquisition was performed at 2° rotational intervals and repeated 1 week later. Magnetic resonance imaging was performed at 0.5 T. End-diastolic and end-systolic LV volumes were derived using Simpson’s rule by manual endocardial tracing of 8 equidistant parallel LV short-axis slices with 3-DE, whereas 9-mm slices were used with magnetic resonance imaging. The mean ± SD of end-diastolic and end-systolic LV volumes (ml) and EF (%) from magnetic resonance imaging were 182 ± 75, 121 ± 76, and 39 ± 18, whereas those from 3-DE were 182 ± 76, 121 ± 77, and 39 ± 18 respectively. Day-to-day measurements of end-diastolic and end-systolic LV volumes, and EF on 3-DE were not significantly different as assessed with SEE (2.7, 1.1, and 2.4, respectively). Intra- and interobserver SEE for calculating end-diastolic and end-systolic LV volumes and EF for magnetic resonance imaging were 6.3, 4.7, and 2.1 and 13.6, 11.5, and 4.7, respectively, whereas those for 3-DE were 3.1, 4.4, and 2.2 and 6.2, 3.8, and 3.6, respectively. Day-to-day variability of LV volume and EF calculation on 3-DE were small and not significantly different for normal and dysfunctional left ventricles. Observer variabilities of 3-DE were fewer than those of magnetic resonance imaging. Therefore, 3-DE is recommended for serial assessment of LV volume and EF in normal and abnormally shaped ventricles.

Section snippets

Subjects

Three-DE and magnetic resonance imaging were performed in 46 subjects including 36 men and 10 women (aged 51 ± 17 years, ranging 26 to 72). Group A included 15 healthy volunteers (aged 32 ± 7 years, men only). Group B included 31 patients (21 men and 10 women, aged 54 ± 18 years) with the diagnosis of ischemic heart disease demonstrating either regional (n = 19) or global (n = 12) wall motion abnormalities. All subjects studied were in sinus rhythm. The mean ± SD of their heart rate was 78 ± 10

Results

The mean ± SD of end-diastolic and end-systolic LV volumes and EF calculated by 3-DE and magnetic resonance imaging from all the subjects as well as from groups A and B are listed in Table I. Results from both techniques showed excellent correlation (r = 0.98, 0.98, and 0.98), with close limits of agreement (mean difference ± 2 SD)30 (−1.4 ± 27, −1.5 ± 21, and 0.2 ± 5.1) and nonsignificant differences (p = 0.6, 0.7, and 0.5) when calculating LV end-diastolic and end-systolic volume and EF,

Discussion

Accurate and reproducible assessment of LV volume and function has important clinical significance in most cardiac disorders. Three-DE has been shown to be accurate for evaluating LV volume and function comparison with many accepted techniques.20., 21., 22., 23., 24., 25., 26., 27. The results of this study demonstrate that 3-DE is a highly reproducible technique and is more favorable than magnetic resonance imaging in evaluating LV volume with low observer variability. This is consistent with

Acknowledgements

We would like to thank Rene Frowijn for his technical assistance throughout this work.

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