Assessment Of Left Ventricular Size Research Articles

Leveraging the Capabilities of AI: Novice Neurology-Trained Operators Performing Cardiac POCUS in Patients with Acute Brain Injury.

Cardiac point-of-care ultrasound (cPOCUS) can aid in the diagnosis and treatment of cardiac disorders. Such disorders can arise as complications of acute brain injury, but most neurologic intensive care unit (NICU) providers do not receive formal training in cPOCUS. Caption artificial intelligence (AI) uses a novel deep learning (DL) algorithm to guide novice cPOCUS users in obtaining diagnostic-quality cardiac images. The primary objective of this study was to determine how often NICU providers with minimal cPOCUS experience capture quality images using DL-guided cPOCUS as well as the association between DL-guided cPOCUS and change in management and time to formal echocardiograms in the NICU. From September 2020 to November 2021, neurology-trained physician assistants, residents, and fellows used DL software to perform clinically indicated cPOCUS scans in an academic tertiary NICU. Certified echocardiographers evaluated each scan independently to assess the quality of images and global interpretability of left ventricular function, right ventricular function, inferior vena cava size, and presence of pericardial effusion. Descriptive statistics with exact confidence intervals were used to calculate proportions of obtained images that were of adequate quality and that changed management. Time to first adequate cardiac images (either cPOCUS or formal echocardiography) was compared using a similar population from 2018. In 153 patients, 184 scans were performed for a total of 943 image views. Three certified echocardiographers deemed 63.4% of scans as interpretable for a qualitative assessment of left ventricular size and function, 52.6% of scans as interpretable for right ventricular size and function, 34.8% of scans as interpretable for inferior vena cava size and variability, and 47.2% of scans as interpretable for the presence of pericardial effusion. Thirty-seven percent of screening scans changed management, most commonly adjusting fluid goals (81.2%). Time to first adequate cardiac images decreased significantly from 3.1 to 1.7days (p < 0.001). With DL guidance, neurology providers with minimal to no cPOCUS training were often able to obtain diagnostic-quality cardiac images, which informed management changes and significantly decreased time to cardiac imaging.

Antagonism of contractile forces in left ventricular hypertrophy: a diagnostic challenge for better pathophysiological and clinical understanding

Cardiac function is characterised by haemodynamic parameters in the clinical scenario. Due to recent development in imaging techniques, the clinicians focus on the quantitative assessment of left ventricular size, shape...

Rapid cardiac MRI protocol for cardiac assessment in paediatric and young adult patients undergoing haematopoietic stem cell transplant: a feasibility study.

Haematopoietic stem cell transplantation is an important and effective treatment strategy for many malignancies, marrow failure syndromes, and immunodeficiencies in children, adolescents, and young adults. Despite advances in supportive care, patients undergoing transplant are at increased risk to develop cardiovascular co-morbidities. This study was performed as a feasibility study of a rapid cardiac MRI protocol to substitute for echocardiography in the assessment of left ventricular size and function, pericardial effusion, and right ventricular hypertension. A total of 13 patients were enrolled for the study (age 17.5 ± 7.7 years, 77% male, 77% white). Mean study time was 13.2 ± 5.6 minutes for MRI and 18.8 ± 5.7 minutes for echocardiogram (p = 0.064). Correlation between left ventricular ejection fraction by MRI and echocardiogram was good (ICC 0.76; 95% CI 0.47, 0.92). None of the patients had documented right ventricular hypertension. Patients were given a survey regarding their experiences, with the majority both perceiving that the echocardiogram took longer (7/13) and indicating they would prefer the MRI if given a choice (10/13). A rapid cardiac MRI protocol was shown feasible to substitute for echocardiogram in the assessment of key factors prior to or in follow-up after haematopoietic stem cell transplantation.

Echocardiographic assessment of left ventricular size and systolic function in Warmblood horses using linear measurements, area-based indices, and volume estimates: A retrospective database analysis.

BackgroundEchocardiographic assessment of left ventricular (LV) size and function using area‐based indices and volumetric estimates is not well established in horses.ObjectiveTo report reference intervals and measurement variability for uni‐, 2‐, and 3‐dimensional echocardiographic indices of LV size and systolic function in Warmblood horses and to provide proof of concept for allometric scaling of variables to body weight. Unidimensional indices were to be compared to area‐based indices and LV volume estimates to establish their clinical use.AnimalsThirty healthy Warmblood horses and 70 Warmblood horses with a primary diagnosis of mitral regurgitation or aortic regurgitation.MethodsEchocardiographic indices of LV size and systolic function were measured using an existing echocardiography database. Weight‐related variables were scaled to body weight (BWT). Reference intervals and measurement variability were calculated, the influence of valvular regurgitation on LV size and function was investigated and agreement between different variables for detection of reduced, normal, and increased LV size and systolic function was assessed.ResultsReference values for healthy Warmblood horses were reported. Measurement variability was sufficiently low for clinical use of all variables. Allometric scaling was effective to correct diastolic LV dimensions and cardiac output for differences in BWT. Various echocardiographic indices resulted in different conclusions regarding identification of LV enlargement and systolic dysfunction in healthy horses and horses with valvular regurgitation.Conclusions and Clinical ImportanceEchocardiographic assessment of LV size and systolic function should include joint assessment of multiple uni‐ and multidimensional indices. Area‐based or volumetric indices that reflect LV long‐axis motion should be included.

On-call transthoracic echocardiographic interpretation by first year cardiology fellows: comparison with attending cardiologists

BackgroundTransthoracic echocardiograms (TTE) performed and interpreted by cardiology fellows during off-duty hours are critical to patient care, however limited data exist on their interpretive accuracy. Our aims were to determine the discordance rate between TTEs performed and interpreted by cardiology fellows and National Board of Echocardiography certified attending cardiologists and to identify factors associated with discordance.MethodsConsecutive on-call TTEs acquired and interpreted by 1st year cardiology fellows over 4.6 years at an academic center were prospectively evaluated by attending cardiologists. Fellow interpretations were classified as concordant or discordant with the attending interpretation. We assessed the association of patient, imaging and fellow characteristics with discordance.ResultsA total of 777 TTE interpretations (730 patients) were performed/interpreted by 40 first year fellows and overread by 13 attendings. The most common indications were assessment of left ventricular function (40.9%) and pericardial effusion (37.3%). There was a major or minor discordance in 4.1 and 17.4% of studies, respectively with 42.1% of disagreements occurring in assessment of left ventricular size and function. The indication to assess left ventricular function [OR 2.19, 95% CI (1.32, 3.62), P = 0.002 vs. pericardial effusion] and greater duration of echocardiographic image acquisition (OR 1.02, 95% CI 1.01, 1.03, P = 0.004) were independently associated with overall discordance.ConclusionsIn this large prospective study we found that attending cardiologists disagreed with 1 in 5 fellow TTE interpretations. Standardized tools for evaluation of echocardiograms performed by fellows are needed to ensure quality of training and patient safety.

Assessment of left ventricular size and function by 3-dimensional transthoracic echocardiography: Impact of the echocardiography platform and analysis software

BackgroundWhether echocardiography platform and analysis software impact left ventricular (LV) volumes, ejection fraction (EF), and stroke volume (SV) by transthoracic tridimensional echocardiography (3DE) has not yet been assessed. Hence, our aim was to compare 3DE LV end-diastolic and end-systolic volumes (EDV and ESV), LVEF, and SV obtained with echocardiography platform from 2 different manufacturers. Methods3DE was performed in 84 patients (65% of screened consecutive patients), with equipment from 2 different manufacturers, with subsequent off-line postprocessing to obtain parameters of LV function and size (Philips QLAB 3DQ and General Electric EchoPAC 4D autoLVQ). Twenty-five patients with clinical indication for cardiac magnetic resonance imaging served as a validation subgroup. ResultsLVEDV and LVESV from 2 vendors were highly correlated (r = 0.93), but compared with 4D autoLVQ, the use of Qlab 3DQ resulted in lower LVEDV and LVESV (bias: 11 mL, limits of agreement: −25 to +47 and bias: 6 mL, limits of agreement: −22 to +34, respectively). The agreement between LVEF values of each software was poor (intraclass correlation coefficient 0.62) despite no or minimal bias. SVs were also lower with Qlab 3DQ advanced compared with 4D autoLVQ, and both were poorly correlated (r = 0.66). Consistently, the underestimation of LVEDV, LVESV, and SV by 3DE compared with cardiac magnetic resonance imaging was more pronounced with Philips QLAB 3DQ advanced than with 4D autoLVQ. ConclusionsThe echocardiography platform and analysis software significantly affect the values of LV parameters obtained by 3DE. Intervendor standardization and improvements in 3DE modalities are needed to broaden the use of LV parameters obtained by 3DE in clinical practice.

A Comparison Between Qualitative Assessment of Left Ventricular Size and Systolic Function with Quantitative Measures

Background: Assessment of left ventricular (LV) function and volumes is the cornerstone of cardiac diagnostics. In a busy clinical service, echocardiographers frequently estimate overall size and contractility without formal quantification. While visual estimation of LV systolic function, even after limited training, has been proven to be reasonably accurate, qualitative assessment of LV size and function has significant inter-observer variability and is related to interpreter skill level. Methods: 25 subjects were asked to visually assess LV size, systolic function and LVEF for 11 test patients with varying grades of LV size and systolic function. The blinded subjects comprised of cardiologists, cardiology advanced trainees, sonographers and sonographer students in a set time frame. All test subjects were blinded and parameters of interest were compared to 2D quantitative echo measurements and cardiac MRI. Results: The 25 subjects comprised 8 cardiologists, 3 advanced trainees, 7 sonographers and 7 sonography students. LV size and function was accurately assessed visually by only approximately half of the subjects with <40% providing an accurate assessment of LVEF. Severe grades of LV dilatation of systolic function were most accurately identified. However, mild and moderate grades of LV size and systolic function had the poorest scores regardless of image quality. Conclusion: The results highlight that the level of experience plays a significant role in the accuracy of qualitative assessments. Additionally, the need for quantitation of left ventricular size and systolic function particularly for the mild and moderate grades of severity is highlighted to ensure accurate interpretation.

Assessment of the accuracy of common clinical thresholds for cardiac morphology and function by transthoracic echocardiography

We evaluated the ability of transthoracic echocardiography (TTE) to correctly identify abnormal left ventricular (LV) size, function, and mass when compared to cardiac magnetic resonance (CMR). Whilst numerous studies have compared TTE and CMR with respect to correlation between measurements and study reproducibility, few have employed categorical analysis relevant to clinical practice. Two hundred and fifteen consecutive patients who underwent both TTE and CMR were evaluated for the presence of abnormal LV size, systolic function, and mass. Abnormal LV systolic function was further categorized into grades (mild, moderate, and severe). Quantification of LV morphology and function was performed on TTE and CMR according to published guidelines. The level of agreement between TTE and CMR was compared across binary and categorical variables using Cohen's kappa. Compared to CMR, TTE demonstrated excellent agreement in identification of abnormal versus normal function (κ=0.87). However, agreement across grades of LV function was less strong (κ=0.63). Whilst agreement for identification of severe LV dysfunction was good (κ=0.68), this would still lead to misclassification of severe dysfunction in approximately one in seven cases. Agreement between TTE and CMR was moderate to good for identification of LV dilation (κ=0.43-0.63), but poor for identification of increased mass (κ=0.04). Whilst in clinical practice TTE performs well in identification of normal versus abnormal systolic function, it has substantial limitations across grades of dysfunction and in the assessment of LV size and mass. These limitations have important implications when considering management decisions for patients based on thresholds of LV morphology or function.

Comparison Between Left Ventriculography (LVG) and Transthoracic Echocardiography (TTE) in Assessment of Left Ventricular Size (LVS) and Systolic Function (LVF) - An Australian Centre Study

Comparison Between Left Ventriculography (LVG) and Transthoracic Echocardiography (TTE) in Assessment of Left Ventricular Size (LVS) and Systolic Function (LVF) - An Australian Centre Study

Simpson's Method of Discs for Measurement of Echocardiographic End‐Diastolic and End‐Systolic Left Ventricular Volumes: Breed‐Specific Reference Ranges in Boxer Dogs

BackgroundBoxer dogs are predisposed to congenital and adult onset cardiac diseases. Breed‐specific reference values for M‐mode and Doppler echocardiographic measurements previously have been established. Left ventricular (LV) end‐systolic (ESV) and end‐diastolic volumes (EDV) can be measured by M‐mode or two‐dimensional methods, such as Simpson's method of discs (SMOD). Reference ranges for SMOD‐derived LV volumes are lacking.ObjectivesTo determine reference intervals for EDV and ESV in Boxer dogs.AnimalsPreviously collected data from 85 healthy Boxers (37 males and 48 females) were used for analysis.MethodsSimpson's method of discs‐derived EDV and ESV were measured using offline analysis by 1 observer, in both the right parasternal and the left apical views. Measurements were compared between both views and between male and female dogs using a t‐test. Reference intervals were established using the mean + 2 × SD.ResultsMeasurements obtained from both views showed good agreement, and mean EDVI and ESVI, indexed to body surface area (BSA), were calculated. Reference intervals were 49–93 mL/m² for EDVI, and 22–50 mL/m² for ESVI. EDV and ESV were significantly higher in males compared with females, when indexing to BSA, but not when indexing to body weight.Conclusion and Clinical ImportanceThe upper limit for ESVI exceeds the previously suggested cut‐off of 30 mL/m² for detection of systolic dysfunction. The reference intervals generated in this study should be useful clinically in the assessment of LV size and function in Boxer dogs.

Challenges to the Clinical Integration of Transthoracic Three-Dimensional Echocardiography

One of the most important transformations in echocardiography over the past decade has been the widespread adoption of three-dimensional (3D) transesophageal echocardiography (TEE) for evaluation of the mitral valve. This acceptance occurred after the introduction of the matrix array transducer, which streamlined data acquisition, allowing practical clinical acquisition times and visualization of acquired 3DE images in real-time [1]. The quality of these images is high in the majority of patients, facilitating training, interpretation and the clinical use of these images. These advantages led to the performance of multiple studies, which demonstrated improved clinical diagnosis with their use and so became part of societal guideline recommendations [2]. With increasing user-friendliness with this technology, many centers have expanded the use of 3D TEE to include the peri-procedural monitoring, assessment and guidance of a variety of transcatheter procedures [3]. In contrast to the widespread implementation of 3D TEE, 3D transthoracic echocardiography (TTE) has not experienced a similar increase in clinical use. This is despite many studies demonstrating its value in improving the assessment of left ventricular size and function, which is one of the core requests of most echocardiography laboratories [4–6]. For many years, one of the major limitations to the integration of 3D TTE into routine clinical practice was the requirement to change probes mid-study to acquire 3D images. With the development of transthoracic transducers that allow acquisition of both two-dimensional (2D) and 3DE images using a single probe, a more practical and rapid clinical workflow has become possible. More importantly, the 2D echocardiographic (2DE) image quality obtained from these combined 2D/3D probes are of equal quality to that of previously dedicated 2D probes. However, for 3D TTE to gain similar clinical acceptance to 3D TEE, additional technical improvements in 3D echocardiographic transducers and systems/software need to be developed. These areas include: 1) improvements in spatial and temporal resolution without increasing acquisition or post-processing time; 2) development of automated software that provides quantification of 3D echocardiographic datasets and is integrated into reporting systems; and 3) improvement of storage of 3D echocardiography datasets and analytical results into current reporting systems.

Differences in classification of left ventricular size measured by diameter and volume with contrast echocardiography

Background: Left Ventricular (LV) size is commonly assessed at echocardiography by measurement of the End-Diastolic Diameter (EDD) in the parasternal long axis view. However, this has recognized limitations, and volumetric measurement from apical views is considered superior, particularly with the use of echocardiographic contrast to improve endocardial border definition. We sought to determine the agreement in classification of LV size by these different measures in a large population of patients undergoing clinically indicated echocardiography. Methods: Data were analyzed retrospectively from consecutive patients (n=2008, 61% male, age 62±13 years) who received echocardiographic contrast for LV opacification over 3 years in a single institution. Repeat studies were not included. LVEDD was measured, and LV End-Diastolic Volume (LVEDV) calculated using Simpson's biplane method. Both measures were indexed to body surface area (BSA) and categorized according to ASE guidelines as normal, mild, moderate or severely dilated. Results: There was a good overall correlation between LVEDD and LVEDV (Spearman's rho 0.74, p<0.001). However, when patients were categorized by indexed (i) LV diameter and volume there was poor agreement in classification (kappa = 0.200). Of 320 patients with severely dilated LVEDVi, only 43 were similarly classified by LVEDDi. Furthermore, 173 patients (54%) with a severely dilated LVEDVi had an LVEDDi in the normal range. View this table: Classification of LV size Conclusion: Agreement between different recommended measures of LV size is limited, even with significant LV dilation. The use of LVEDDi as the sole measure of ventricular size risks under-diagnosing or underestimating the degree of LV dilation. This has implications for reporting in circumstances where accurate assessment of LV size is important, such as timing of surgery in asymptomatic valve disease or classification of cardiomyopathy.

Assessment of Left Ventricular Size and Function during Cardiac Surgery. An Intraoperative Evaluation of Six Two‐Dimensional Echocardiographic Methods with Real Time Three‐Dimensional Echocardiography as a Reference

Transesophageal echocardiography is recommended to monitor left ventricular (LV) size and function in various operations. Generally, two-dimensional (2D) methods are applied intraoperatively. The aim of this study was to compare the accuracy and feasibility of 6 commonly used 2D methods to assess LV function during surgery. LV function in 120 consecutive patients was evaluated. Real time three-dimensional transesophageal echocardiograpy (3DTEE) served as reference. End-diastolic and end-systolic volumes and ejection fraction (EF) were analyzed with Simpson's method of discs (monoplane [MP] and biplane [BP]), eyeball method, Teichholz' method, and speckle tracking (ST) methods. Furthermore, fractional area change (FAC) and peak systolic pressure rise (dP/dt) were determined. Each 2D method was evaluated regarding correlation and agreement with 3DE, intra- and interobserver variability and the time required for evaluation. Simpson BP showed the strongest correlation and best agreement with 3DE for EF (limits of agreement 3.7±11.6%) and volumes. Simpson MP showed similar agreement with 3DE compared to ST (2.8±14.5% vs. 2.0±15.3% and 3.8±14.4% vs. 1.9±15.6%, respectively). Both the eyeball method and Teichholz' method showed wide limits of agreement (-1.5±18.2% and 5.2±22.1%, respectively). DP/dt did not correlate with 3DE. FAC and ST FAC showed similar agreement. Application of 3DE (429±108seconds) took the longest time, and the eyeball method took the shortest time (8±5seconds) for analysis. Simpson BP is the most accurate intraoperative 2D method to evaluate LV function, followed by long-axis MP evaluations. Short-axis views were less accurate but may be suited for monitoring. We do not recommend using dP/dt.

Routine Chest X-ray: Still Valuable for the Assessment of Left Ventricular Size and Function in the Era of Super Machines?

Objectives:The development of technologically advanced, expensive techniques has progressively reduced the value of chest X-ray in clinical practice for the assessment of left ventricular (LV) dilatation and dysfunction. Although controversial data are reported on the role of this widely available technique in cardiac assessment, it is known that the cardio-thoracic ratio is predictive of risk of progression in the NYHA Class, hospitalization, and outcome in patients with LV dysfunction. This study aimed to evaluate the reliability of the transverse diameter of heart shadow [TDH] by chest X-ray for detecting LV dilatation and dysfunction as compared to Magnetic Resonance Imaging (MRI) performed for different clinical reasons.Materials and Methods:In 101 patients, TDH was measured in digital chest X-ray and LV volumes and ejection fraction (EF) by MRI, both exams performed within 2 days.Results:A direct correlation between TDH and end-diastolic volumes (r = .75, P<0.0001) was reported. TDH cut-off values of 14.5 mm in females identified LV end-diastolic volumes >150 mL (sensitivity: 82%, specificity: 69%); in males a cut-off value of 15.5 mm identified LV end-diastolic volumes >210 mL (sensitivity: 84%; specificity: 72%). A negative relation was found between TDH and LVEF (r = -.54, P<0.0001). The above cut-off values of TDH discriminated patients with LV systolic dysfunction – LVEF <35% (sensitivity and specificity: 67% and 57% in females; 76% and 59% in males, respectively).Conclusions:Chest X-ray may still be considered a reliable technique in predicting LV dilatation by the accurate measurement of TDH as compared to cardiac MRI. Technologically advanced, expensive, and less available imaging techniques should be performed on the basis of sound clinical requests.

Assessment of left ventricular size and function in horses using anatomical M-mode echocardiography

Objective To study the applicability of anatomical M-mode (AMM) for assessment of left ventricular (LV) size and function in horses, evaluate agreement with conventional M-mode (CMM), determine reliability, and establish reference intervals for AMM measurements. Animals 98 horses; 13.1 ± 5.6 years; 538 ± 78 kg. Methods Two-dimensional and M-mode recordings were analyzed retrospectively. Standard LV dimensions and indices of LV function, including time intervals, were measured in CMM and compared with AMM studies in long-axis (lx) and short-axis (sx) views. Results The percentages of measureable cycles were 99%, 97%, and 90% for routine LV studies in CMM sx, AMM sx, and AMM lx mode. For time intervals, ≥ 93% of cycles could be measured using AMM compared to a maximum of 77% using CMM. AMM sx measurements agreed well with CMM sx measurements for LV studies; the agreement of AMM lx with CMM sx was markedly lower. The LV ejection time and the duration of electromechanical systole, but not the LV pre-ejection period and the index of myocardial performance, showed fair agreement between methods. Intraobserver and interobserver measurement variabilities were low for most variables. Conclusions AMM can replace CMM for assessment of LV dimensions in horses, but is not recommended for measurement of time intervals.

The Accuracy of Echocardiographic Assessment of Left Ventricular Size in Children by the 5/6 Area × Length (Bullet) Method

Left ventricular end-diastolic volume (LVEDV) calculation is important in decision making in children with congenital heart disease (CHD). This study examined the accuracy of LVEDV calculation by the formula: 5/6 x area x length ("bullet" method), by comparing echocardiographic (ECHO) LVEDV against cardiac magnetic resonance (CMR). ECHO and CMR data from 72 consecutive subjects with CHD < or =10 years of age were retrospectively reviewed. Exclusion criteria included: >3 months between examinations; unavailable or poor-quality images. Subxiphoid short- and long-axis echocardiographic images were analyzed. Bullet LVEDV was compared to CMR volumes. Seventeen subjects (median age 5.5 years, range 1-10 years) comprised the study group. ECHO and CMR LVEDV showed an excellent correlation (r = 0.97) and a good agreement with a mean difference (limits of agreement) of -1.0 mL (-13.9 to 11.9 mL). Subxiphoid echocardiographic bullet method of measuring LVEDV shows a good agreement with CMR obtained LV size in young children.

Assessment of left ventricular function in non-dilated and dilated hearts: Comparison of contrast-enhanced 2-dimensional echocardiography with multi-detector row CT angiography

Objective— Multidetector-row CT (MDCT) and contrast-enhanced echocardiography (CEE) are being increasingly used for assessment of left ventricular (LV) function. Excellent spatial and contrast resolution of MDCT allows this evaluation along with coronary angiography. CEE improves the accuracy of 2D echocardiography. Data on side-by-side comparison of both techniques for assessment of LV size and function in subjects with a non-dilated or dilated left ventricle are limited.Methods and results— Our study population included 64 patients. Group I included 31 patients with an implanted pacemaker who had a non-dilated left ventricle with preserved systolic function. Group II comprised 33 patients with dilated cardiomyopathy and severe systolic LV dysfunction. LV end-diastolic and end-systolic volumes (LVEDV, LVESV) and ejection fraction (LVEF) were assessed using both CEE and short-axis MDCT.The results obtained by both techniques were compared by linear regression and Bland-Altman analysis.Additionally, intra- and interobserver reproducibility was assessed. Both CEE and MDCT measurements highly correlated (r = 0.61-0.94). However, CEE significantly underestimated LVEDV and LVESV, and this bias was higher with enlarged LV volumes. LVEF was overestimated by CEE in both groups with a higher bias in the group with preserved systolic function. Both intra- and interobserver reproducibility was significantly better for MDCT, the worst reproducibility was observed for CEE in group I.Conclusion— Despite a high correlation between MDCT and CEE measurements, CEE provides consistently lower volumes and higher LVEF.This suggests that both methods are not completely interchangeable. Reproducibility of CEE is inferior to reproducibility of MDCT, especially in non-dilated left ventricles with preserved function.

Noninvasive Detection of Fibrosis Applying Contrast-Enhanced Cardiac Magnetic Resonance in Different Forms of Left Ventricular Hypertrophy: Relation to Remodeling

We aimed to evaluate the incidence and patterns of late gadolinium enhancement (LGE) in different forms of left ventricular hypertrophy (LVH) and to determine their relation to severity of left ventricular (LV) remodeling. Left ventricular hypertrophy is an independent predictor of cardiac mortality. The relationship between LVH and myocardial fibrosis as defined by LGE cardiovascular magnetic resonance (CMR) is not well understood. A total of 440 patients with aortic stenosis (AS), arterial hypertension (AH), or hypertrophic cardiomyopathy (HCM) fulfilling echo criteria of LVH underwent CMR with assessment of LV size, weight, function, and LGE. Patients with increased left ventricular mass index (LVMI) resulting in global LVH in CMR were included in the study. Criteria were fulfilled by 83 patients (56 men, age 57 +/- 14 years; AS, n = 21; AH, n = 26; HCM, n = 36). Late gadolinium enhancement was present in all forms of LVH (AS: 62%, AH: 50%; HCM: 72%, p = NS) and was correlated with LVMI (r = 0.237, p = 0.045). There was no significant relationship between morphological obstruction and LGE. The AS subjects with LGE showed higher LV end-diastolic volumes than those without (1.0 +/- 0.2 ml/cm vs. 0.8 +/- 0.2 ml/cm, p < 0.015). Typical patterns of LGE were observed in HCM but not in AS and AH. Fibrosis as detected by CMR is a frequent feature of LVH, regardless of its cause, and depends on the severity of LV remodeling. As LGE emerges as a useful tool for risk stratification also in nonischemic heart diseases, our findings have the potential to individualize treatment strategies.

Fast Data Acquisition and Analysis with Real Time Triplane Echocardiography for the Assessment of Left Ventricular Size and Function: A Validation Study

To assess accuracy and reproducibility of real time simultaneous triplane echocardiography (RT3PE) for the assessment of left ventricular (LV) volumes and ejection fraction (EF) using cardiac magnetic resonance (CMR) as a reference method. A total of 24 patients with various degrees of LV dysfunction (EF from 36 to 57%) in sinus rhythm with good image quality were enrolled in the study. Digital loops of apical views were recorded with standard two-dimensional imaging and with RT3PE. Echocardiography and CMR were performed within 1 hour. RT3PE measurements of LV end-diastolic volume, end-systolic volume, and EF resulted closely correlated to CMR (r = 0.95, 0.97, and 0.95, respectively) with small biases (-4 ml, -6 ml, and 1%, respectively) and narrow limits of agreement (SD = 15 ml, 12 ml, and 6%, respectively). Two-dimensional echocardiography (2DE) showed a weaker correlation with CMR (r = 0.85, 0.91, and 0.83, respectively; P < 0.06) with similar biases (-4 ml, -10 ml, 5%, respectively), but wider limits of agreement (SD = 28 ml, 21 ml, 10%, respectively, P < 0.007). RT3PE showed lower interobserver variability for the assessment of EF (SD = 2% vs. 5%, P = 0.03) and lower measurement time of LV EF (175 +/- 54 sec vs. 241 +/- 49 sec, respectively; P < 0.0001), as compared to 2DE. RT3PE allows simple and fast image acquisition and volume calculation. In addition, it allows more accurate and reproducible EF measurements than conventional 2DE.

Assessment of left ventricular size and function in neonates with critical aortic stenosis or severe left ventricular outflow tract obstruction

Assessment of left ventricular size and function in neonates with critical aortic stenosis or severe left ventricular outflow tract obstruction