Left ventricular mass estimation by real-time 3D echocardiography favourably competes with CMR in congenital left ventricular disease

Miriam Michel,Anca Racolta,Hermann Körperich,Andrea Kelter-Klöpping,Wael Shabanah,Andreas Entenmann,Kai Thorsten Laser

doi:10.1038/s41598-019-48375-y

Abstract

Assessment of left ventricular mass (LVM) is important in the evaluation of patients with congenital heart disease (CHD) and cardiac magnetic resonance imaging (CMR) is the gold standard. Recent software allows LVM calculation by real-time 3-dimensional echocardiography (RT3DE). We investigated the impact of different software analysis tools on LVM determination by CMR or RT3DE in a cohort of patients with heterogeneous left ventricular (LV) disease. 37 subjects (17 patients, mean age 18.7 y; 20 controls, mean age 13.2 y) underwent CMR and RT3DE. CMR LVM and RT3DE calculations were done using two different LV-analysis software packages for each modality: CMR i) customized software “CMR HDZ”, CMR ii) “CMR ISP”; RT3DE i) “Toshiba”, RT3DE ii) “Tomtec”, 4D LV-Analysis Version 3.1 (built 3.1.0.258661). Intra- and interobserver variabilities were calculated. Only RT3DE-derived LVM showed significant software-dependent differences. RT3DE-derived LVM (both softwares) was significantly higher than CMR-derived LVM (both softwares). The two different methods and four evaluation software packages for LVM assessment were well correlated with each other. Intra- and interobserver variability of LVM as assessed by each single modality or software was low. Despite software dependency and overestimation of RT3DE-assessed LVM by 5 to 10%, RT3DE still competes with the gold standard, CMR, even in patients with various forms of LV disease. The use of optimized software, especially for RT3DE, should improve the accuracy of LVM assessment, overcoming LVM overestimation.

Highlights

Non-invasive assessment of left ventricular mass (LVM) is important for monitoring patients with congenital heart disease (CHD)
We investigated the impact of different analysis software systems on the reproducibility of cardiac magnetic resonance imaging (CMR) and of real-time 3-dimensional echocardiography (RT3DE) in measuring LVM in CHD patients with heterogeneous LV disease
Due to poor image quality or incomplete volume capture in RT3DE studies, 2 patients and 1 control had to be excluded from evaluation, resulting in 17 patients (mean age ± standard deviation (SD) = 18.7 ± 16.2 y; range 0.1 to 72.9 y, 7 female) and 20 healthy individuals (13.2 ± 3.4 y; range 7.1 to 19.4 y, 9 female) included into the study

Summary

Introduction

Non-invasive assessment of left ventricular mass (LVM) is important for monitoring patients with congenital heart disease (CHD). Up to now the gold standard for mass assessment has been cardiac magnetic resonance imaging (CMR)[1]. While standard-formula based mass estimation by 2-dimensional (2D) echocardiography risks inaccuracies, new software developments allow real-time 3-dimensional echocardiography (RT3DE)- based calculation of LVM2,3. The influence of different software for LVM in pediatric, adolescent, and adult patients with heterogenous congenital LV disease, in particular, has not been addressed. Due to bed-side availability, low cost, short examination time, and lack of need for sedation with RT3DE, it is important to know how RT3DE competes with the gold standard, CMR. We investigated the impact of different analysis software systems on the reproducibility of CMR (as reference) and of RT3DE in measuring LVM in CHD patients with heterogeneous LV disease

Methods

Results

Conclusion