Quantification Of Left Ventricular Volumes Research Articles

Using computed tomography fusion imaging as learning data for sonographer training in identification of left ventricular endocardial boundaries

BackgroundWe hypothesized that if computed tomography (CT) images were used as learning data, we could overcome volume underestimation by echocardiography, improving the accuracy of left ventricular (LV) volume measurements. MethodsWe utilized a fusion imaging modality consisting of echocardiography with superimposed CT images for 37 consecutive patients to identify the endocardial boundary. We compared LV volumes obtained with and without CT learning trace-lines (TLs). Furthermore, 3D echocardiography was used to compare LV volumes obtained with and without CT learning for endocardial identification. The mean difference between the echocardiography and CT-derived LV volumes and the coefficient of variation were compared pre- and post-learning. Bland–Altman analysis was used to assess the differences in LV volume (mL) obtained from the 2D pre-learning TL and 3D post-learning TL. ResultsThe post-learning TL was located closer to the epicardium than the pre-learning TL. This trend was particularly pronounced in the lateral and the anterior wall. The post-learning TL was along the inner side of the high echoic layer in the basal-lateral wall in the four-chamber view. CT fusion imaging determined that the difference in LV volume between 2D echocardiography and CT was small (−25.6 ± 14.4 mL before learning, −6.9 ± 11.5 mL after learning) and that CT learning improved the coefficient of variation (10.9 % before learning, 7.8 % after learning). Significant improvements were observed during 3D echocardiography; the difference in LV volume between 3D echocardiography and CT was slight (−20.5 ± 15.1 mL before learning, 3.8 ± 15.7 mL after learning), and the coefficient of variation improved (11.5 % before learning, 9.3 % after learning). ConclusionsDifferences between the LV volumes obtained using CT and echocardiography either disappeared or were reduced after CT fusion imaging. Fusion imaging is useful in training regimens for accurate LV volume quantification using echocardiography and may contribute to quality control.

Potential Impact of SPECT Resolution on Quantification of Left Ventricular Volumes and Ejection Fraction: A Phantom Study

Potential Impact of SPECT Resolution on Quantification of Left Ventricular Volumes and Ejection Fraction: A Phantom Study

Hemodynamic forces and myocardial deformation using cine MRI in Marfan syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. Cardiovascular assessment of Marfan syndrome (MS) patients has normally focused on the aortic root and vascular manifestations due to the high risk of aortic dissection. Although primary myocardial impairment has long been suspected, the evidence has been controversial. Advanced in CMR may support the early detection of cardiac dysfunction. Beyond left ventricle ejection fraction (EF) and myocardial strain (S), a new parameter is emerging, the hemodynamic forces (HF) exchanged between the blood flowing in the heart and the myocardium. The application of these techniques to MS could be useful in demonstrating the presence of primary myocardial impairment. Aim. The aim of this study is to explore myocardial function in MS through the evaluation in cine CMR of EF, S and cardiac HF exchanged between the blood and the myocardium and compare these data with those of a control group (C). Methods. We retrospectively analysed CMR cine images of MS (diagnosed according revised Ghent criteria) without valvular disease or previous cardio surgery, and C, in standard long-axis projections, to define endocardial borders for subsequent quantification of left ventricular volumes, EF, longitudinal, circumferential and radial S, apex-to-base and lateral-to-septum HF (expressed in mN and as a percentage of gravity acceleration). The analysis were performed on Medical Imaging Systems (QStrain version 1.3.0.79; MEDIS) (Figure 1). Results. 108 MS and 44 C had a good quality study, suitable for MEDIS analysis. The mean age was 33 ± 13 ys in MS, 35 ± 12 ys in C; 39% were male in MS, 50% in C. The results of left ventricular function were: EF 63 ± 7% in MS vs 66 ± 5% in C group, p .008, global longitudinal S -24.5 ± 4.1% in MS vs -26.2 ± 4.1 in C, p .014; global circumferential S -30.6 ± 6.3% in MS vs -33.8 ± 4.4 in C, p .002; radial S 64.5 ± 16.2% in MS vs 72.7 ± 15.9 in C, p .005; apex-to-base HF 13.2 ± 4.7% in MS vs 17.8 ± 7.6% in C, p .000; lateral-to-septum 2.6 ± 1.3% in MS vs 3.1 ± 1.4% in C, p .048. Moreover, 4.6% MS patients had mid reduced EF (40-50%); 9.2% had global longitudinal S reduction (cut off -19.3%); 7.4% had global circumferential S reduction (cut-off -21.7%). Conclusion. These data provide support for the existence of a cardiomyopathy in MS. In our opinion, the term "primary cardiomyopathy" is not appropriate to describe this condition: patients with MS have changes in aortic stiffness and probably in cardiac afterload. The HF data are the most interesting of this study, both in the validation of this new parameter and in early detection a cardiomyopathy in MS Moreover, the reduction of global circumferential S, as wall as global longitudinal S, in MS patients may help provide new elements to characterize the MS cardiomyopathy: sure enough, in literature, circumferential strain abnormalities are related to afterload increase. HF analysis is really a new challenge of cardiac imaging, as sensitive markers of subtle systolic dysfunction. Abstract Figure. Figue 1. Analisis exemple.

Fully automated quantification of left ventricular volumes and function in cardiac MRI: clinical evaluation of a deep learning-based algorithm

To investigate the performance of a deep learning-based algorithm for fully automated quantification of left ventricular (LV) volumes and function in cardiac MRI. We retrospectively analysed MR examinations of 50 patients (74% men, median age 57 years). The most common indications were known or suspected ischemic heart disease, cardiomyopathies or myocarditis. Fully automated analysis of LV volumes and function was performed using a deep learning-based algorithm. The analysis was subsequently corrected by a senior cardiovascular radiologist. Manual volumetric analysis was performed by two radiology trainees. Volumetric results were compared using Bland–Altman statistics and intra-class correlation coefficient. The frequency of clinically relevant differences was analysed using re-classification rates. The fully automated volumetric analysis was completed in a median of 8 s. With expert review and corrections, the analysis required a median of 110 s. Median time required for manual analysis was 3.5 min for a cardiovascular imaging fellow and 9 min for a radiology resident (p < 0.0001 for all comparisons). The correlation between fully automated results and expert-corrected results was very strong with intra-class correlation coefficients of 0.998 for end-diastolic volume, 0.997 for end-systolic volume, 0.899 for stroke volume, 0.972 for ejection fraction and 0.991 for myocardial mass (all p < 0.001). Clinically meaningful differences between fully automated and expert corrected results occurred in 18% of cases, comparable to the rate between the two manual readers (20%). Deep learning-based fully automated analysis of LV volumes and function is feasible, time-efficient and highly accurate. Clinically relevant corrections are required in a minority of cases.

Accuracy and Time-Efficiency of an Automated Software Tool to Assess Left Ventricular Parameters in Cardiac Magnetic Resonance Imaging.

Routine manual tracing of cardiac contours is time-consuming and subject to variability. A fully automated software tool may improve reading efficiency. This study was performed to assess the accuracy, reliability, and time-efficiency of a fully automated left ventricular (LV) segmentation software tool to calculate LV volumes and function compared with conventional manual contouring. Sixty-seven consecutive patients (53 male, mean age 62.5±10.9 y) underwent adenosine stress/rest perfusion cardiac magnetic resonance examination to rule out myocardial ischemia. Double-oblique short-axis 6-mm slice thickness steady-state free precession cine images were acquired to assess LV ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV) using manual contour tracing and a recently developed fully automated software tool. The length of time needed to obtain LV volumes with each segmentation method was also compared. Compared with manual contouring, the fully automated software tool minimally underestimated LV-EF (mean difference of 2.9%±3.9%) and SV (mean difference of 4.4±8.5 mL) and slightly overestimated ESV (mean difference of -6.4±10.8 mL) and LV mass (mean difference of -14±20.4 g). EDV quantification did not statistically differ. Reliability for EF (concordance correlation coefficient [CCC]=0.92, 95% confidence interval [CI], 0.88-0.95), EDV (CCC=0.98, 95% CI, 0.97-0.99), ESV (CCC=0.96, 95% CI, 0.94-0.97), SV (CCC=0.93, 95% CI, 0.89-0.95), and LV mass (CCC=0.84, 95% CI, 0.76-0.89) was very good. The evaluated software allowed to quantify LV parameters with a 79% reduction in the time required for manual contouring (414.7±91 s vs. 85±16.1 s, respectively, P<0.001). Quantification of LV volumes using the evaluated fully automated segmentation software is accurate and time-efficient.

Quantitative assessment of primary mitral regurgitation using left ventricular volumes obtained with new automated three-dimensional transthoracic echocardiographic software: A comparison with 3-Tesla cardiac magnetic resonance

Quantitative assessment of primary mitral regurgitation (MR) using left ventricular (LV) volumes obtained with three-dimensional transthoracic echocardiography (3D TTE) recently showed encouraging results. Nevertheless, 3D TTE is not incorporated into everyday practice, as current LV chamber quantification software products are time consuming. To investigate the accuracy and reproducibility of new automated fast 3D TTE software (HeartModelA.I.; Philips Healthcare, Andover, MA, USA) for the quantification of LV volumes and MR severity in patients with isolated degenerative primary MR; and to compare regurgitant volume (RV) obtained with 3D TTE with a cardiac magnetic resonance (CMR) reference. Fifty-three patients (37 men; mean age 64±12 years) with at least mild primary isolated MR, and having comprehensive 3D TTE and CMR studies within 24h, were eligible for inclusion. MR RV was calculated using the proximal isovelocity surface area (PISA) method and the volumetric method (total LV stroke volume minus aortic stroke volume) with either CMR or 3D TTE. Inter- and intraobserver reproducibility of 3D TTE was excellent (coefficient of variation≤10%) for LV volumes. MR RV was similar using CMR and 3D TTE (57±23mL vs 56±28mL; P=0.22), but was significantly higher using the PISA method (69±30mL; P<0.05 compared with CMR and 3D TTE). The PISA method consistently overestimated MR RV compared with CMR (bias 12±21mL), while no significant bias was found between 3D TTE and CMR (bias 2±14mL). Concordance between echocardiography and CMR was higher using 3D TTE MR grading (intraclass correlation coefficient [ICC]=0.89) than with PISA MR grading (ICC=0.78). Complete agreement with CMR grading was more frequent with 3D TTE than with the PISA method (76% vs 63%). 3D TTE RV assessment using the new generation of automated software correlates well with CMR in patients with isolated degenerative primary MR.

Realization of fully automated quantification of left ventricular volumes and systolic function using transthoracic 3D echocardiography

BackgroundStudy on automated three-dimensional (3D) quantification of left heart parameters by using Heartmodel software is still in the early stage and fully automatic analysis was not clearly achieved. The aim of our study was to evaluate the performance of this new technology in measuring left ventricular (LV) volume and ejection fraction (EF) in patients with a variety of heart diseases on the basis of rationally determining the default endocardial border values.MethodsSubjects with a variety of heart diseases were included prospectively. High quality Heartmodel images were selected to determine the end-diastolic and end-systolic default values of endocardial border. The accuracy and reproducibility of automated three-dimensional echocardiography (3DE) for measuring LV end-diastolic volume (EDV), end-systolic volume (ESV) and EF were evaluated with the traditional manual 3DE as the relative standard.ResultsNinety seven subjects were enrolled in the study. The default endocardial border values were determined as 66% and 40% for end-diastole (ED) and end-systole (ES), respectively. Most of the subjects (84/97) were automatically analyzed by Heartmodel software without manual adjustment, revealing a close correlation of automated 3DE with manual 3DE in measuring EDV, ESV and EF (r-values: EDV: 0.96, ESV: 0.97, EF: 0.96). The EDV and ESV values obtained by automated 3DE were higher than those measured by manual 3DE (biases: EDV: 16 ± 18 ml, ESV: 11 ± 12 ml). The intra- and inter-observer reproducibility of automated 3DE was better than that of manual 3DE. Automated 3DE with manual adjustment showed good consistency with manual 3DE in assessing the impairment degree of systolic function in patients with wall motion abnormalities (n = 58), (Kappa = 0.74, P = 0.00).ConclusionFully automated 3DE quantification of LV volume and EF could be achieved in most patients. Since automated 3DE was accurate and more reproducible, it could replace the existing manual 3DE technology and be routinely used in clinical practice.

Performance of new automated transthoracic three-dimensional echocardiographic software for left ventricular volumes and function assessment in routine clinical practice: Comparison with 3 Tesla cardiac magnetic resonance

Three-dimensional (3D) transthoracic echocardiography (TTE) is superior to two-dimensional Simpson's method for assessment of left ventricular (LV) volumes and LV ejection fraction (LVEF). Nevertheless, 3D TTE is not incorporated into everyday practice, as current LV chamber quantification software products are time-consuming. To evaluate the feasibility, accuracy and reproducibility of new fully automated fast 3D TTE software (HeartModelA.I.; Philips Healthcare, Andover, MA, USA) for quantification of LV volumes and LVEF in routine practice; to compare the 3D LV volumes and LVEF obtained with a cardiac magnetic resonance (CMR) reference; and to optimize automated default border settings with CMR as reference. Sixty-three consecutive patients, who had comprehensive 3D TTE and CMR examinations within 24hours, were eligible for inclusion. Nine patients (14%) were excluded because of insufficient echogenicity in the 3D TTE. Thus, 54patients (40men; mean age 63±13years) were prospectively included into the study. The inter- and intraobserver reproducibilities of 3DTTE were excellent (coefficient of variation<10%) for end-diastolic volume (EDV), end-systolic volume (ESV) and LVEF. Despite a slight underestimation of EDV using 3D TTE compared with CMR (bias=-22±34mL; P<0.0001), a significant correlation was found between the two measurements (r=0.93; P=0.0001). Enlarging default border detection settings leads to frequent volume overestimation in the general population, but improved agreement with CMR in patients with LVEF≤50%. Correlations between 3DTTE and CMR for ESV and LVEF were excellent (r=0.93 and r=0.91, respectively; P<0.0001). 3DTTE using new-generation fully automated software is a feasible, fast, reproducible and accurate imaging modality for LV volumetric quantification in routine practice. Optimization of border detection settings may increase agreement with CMR for EDV assessment in dilated ventricles.

Improved workflow for quantification of left ventricular volumes and mass using free-breathing motion corrected cine imaging.

BackgroundTraditional cine imaging for cardiac functional assessment requires breath-holding, which can be problematic in some situations. Free-breathing techniques have relied on multiple averages or real-time imaging, producing images that can be spatially and/or temporally blurred. To overcome this, methods have been developed to acquire real-time images over multiple cardiac cycles, which are subsequently motion corrected and reformatted to yield a single image series displaying one cardiac cycle with high temporal and spatial resolution. Application of these algorithms has required significant additional reconstruction time. The use of distributed computing was recently proposed as a way to improve clinical workflow with such algorithms. In this study, we have deployed a distributed computing version of motion corrected re-binning reconstruction for free-breathing evaluation of cardiac function.MethodsTwenty five patients and 25 volunteers underwent cardiovascular magnetic resonance (CMR) for evaluation of left ventricular end-systolic volume (ESV), end-diastolic volume (EDV), and end-diastolic mass. Measurements using motion corrected re-binning were compared to those using breath-held SSFP and to free-breathing SSFP with multiple averages, and were performed by two independent observers. Pearson correlation coefficients and Bland-Altman plots tested agreement across techniques. Concordance correlation coefficient and Bland-Altman analysis tested inter-observer variability. Total scan plus reconstruction times were tested for significant differences using paired t-test.ResultsMeasured volumes and mass obtained by motion corrected re-binning and by averaged free-breathing SSFP compared favorably to those obtained by breath-held SSFP (r = 0.9863/0.9813 for EDV, 0.9550/0.9685 for ESV, 0.9952/0.9771 for mass). Inter-observer variability was good with concordance correlation coefficients between observers across all acquisition types suggesting substantial agreement. Both motion corrected re-binning and averaged free-breathing SSFP acquisition and reconstruction times were shorter than breath-held SSFP techniques (p < 0.0001). On average, motion corrected re-binning required 3 min less than breath-held SSFP imaging, a 37 % reduction in acquisition and reconstruction time.ConclusionsThe motion corrected re-binning image reconstruction technique provides robust cardiac imaging that can be used for quantification that compares favorably to breath-held SSFP as well as multiple average free-breathing SSFP, but can be obtained in a fraction of the time when using cloud-based distributed computing reconstruction.

Evaluation of Left Ventricular Volumes and Function by Real Time Three-Dimensional Echocardiography in Children with Functional Single Left Ventricle: A Comparison between QLAB and TomTec.

Real time three-dimensional echocardiography (RT3DE) provides a reliable analysis of left ventricular (LV) volume. Despite a wide spectrum of tracking algorithms presently available, which software is most suitable for evaluating functional single left ventricle (FLSV) is unknown. Herein, we compared two of the most commonly used 3DE algorithms for quantification of LV volumes in the pediatric population with FLSV. Thirty-six children with FLSV were prospectively enrolled. The LV volume analysis was performed on QLAB 8.1 (semiautomated border tracking) and TomTec 4D LV 3.0 (manual dominant border tracking) and compared with MRI as the reference standard. 3DE volume quantification was achieved for 32 children with QLAB and 34 children with TomTec. Analysis time was much shorter for QLAB than TomTec (4.8 ± 1.2 vs. 6.3 ± 1.8 minutes, P < 0.05). Ejection fraction (EF) by either 3DE modality was significantly lower than the published normal values (P < 0.01 for each). End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume, and EF calculated by both 3DE modalities underestimated MRI values. Compared to QLAB, TomTec showed better correlation and smaller intertechnique differences with MRI (the 95% limits of agreement, EDV: -20.84 to 5.18 mL in QLAB, -10.66 to 1.84 mL in TomTec; ESV: -8.94 to 3.07 mL in QLAB, -2.45 to 0.98 mL in TomTec; SV: -13.31 to 3.45 mL in QLAB, -9.34 to 2.0 mL in TomTec; EF: -12.07 to 7.76% in QLAB, -9.64 to 1.52% in TomTec), TomTec was more reproducible with better intraclass correlation coefficients and variation coefficients. Both 3DE modalities tend to underestimate LV volumes, but the correlation of LV volumes and EF between 3DE and MRI still holds well. Despite a longer operating time, TomTec analysis is more accurate and reproducible.

Three-dimensional echocardiography in a dynamic heart phantom: comparison of five different methods to measure chamber volume using a commercially available software.

Several methods of analysis are available for quantification of left ventricular volumes and ejection fraction using three-dimensional (3D) echocardiography. This study compared the accuracy and reproducibility of five methods of analysis in a novel, irregularly shaped dynamic heart phantom with excellent image quality. Five 3D datasets were acquired on a Philips IE33 platform using an X5-1 3D transducer. Each dataset was analysed by five different methods using the Philips QLab v8.1 software: Methods A1, A2 and A3, semi-automated contour detection with varying degrees of user correction; Method B, Simpson's biplane method using optimally aligned four- and two-chamber views and Method C, method of discs, manually delineated in reconstructed short-axis views. Time–volume curves were generated for each method and compared with the true volumes measured throughout systole in the phantom heart. A second observer repeated measurements by each method in a single 3D dataset. Method A1 (uncorrected semi-automated contouring) produced the most consistent time–volume curves, although end-diastolic and end-systolic volumes varied between datasets. Any manual correction of contours (Methods A2, A3 and B) resulted in significant variation in the time–volume curves, with less consistent endocardial tracking. Method C was not only the most accurate and reproducible method, but also the most time-consuming one. Different methods of 3D volume quantification vary significantly in accuracy and reproducibility using an irregular phantom heart model. Although contouring may appear optimal in long-axis views, this may not be replicated circumferentially, and the resulting measures appeared to be less robust following the manual correction of semi-automated contours.

Single-beat real-time three-dimensional echocardiographic automated contour detection for quantification of left ventricular volumes and systolic function

To assess the feasibility and accuracy in measuring left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) with Siemens single-beat real-time 3D transthoracic echocardiography. The LV volumes and EF were measured in 3D datasets acquired by six imaging modes (time-1-harmonic (T1H), time-1-fundamental, time-2-harmonic, time-2-fundamental, space-1-harmonic (S1H), and space-1-fundamental) in 41 patients using the automated contouring algorithm and compared with manually corrected 3DE QLAB measurements. The main determinates of the temporal and spatial resolutions of 3D datasets acquired were the fundamental and harmonic modes. Consequently, the S1H mode had the lowest volume rate and highest spatial resolution. Compared with the 3DE QLAB analysis, the S1H mode resulted in the best LV volumes and EF estimates in all patients (0 ± 10 % for EF, -7 ± 44 ml for EDV, -7 ± 39 ml for ESV) and in the 10 patients with correct LV contour tracking according to a visual assessment from the multiplanar reconstruction views in all six modes (0 ± 9 % for EF, -3 ± 23 ml for EDV, -2 ± 14 ml for ESV). The T1H mode was the best alternative. Overall 28 patients (68 %) could be analysed automatically and satisfyingly with the S1H and T1H modes: 0 ± 8 % (EF), 0 ± 27 ml (EDV) and -1 ± 16 ml (ESV). The accuracy of the Siemens automated RT-3D algorithm in measuring LV volumes and EF is significantly influenced by the different imaging modes. The S1H mode may be the preferred 3D acquisition mode, supplemented by the T1H mode in enlarged LVs that do not fit in the S1H acquisition sector.

Novel single-beat full-volume capture real-time three-dimensional echocardiography and auto-contouring algorithm for quantification of left ventricular volume: Validation with cardiac magnetic resonance imaging

term follow-up periods. We believe that the treatment of Kounis syndrome must be individualized until there is a determination of the best therapy byevaluating the effectiveness of different treatment choices for reducing cardiovascular endpoints. Supplementary data to this article can be found online at http:// dx.doi.org/10.1016/j.ijcard.2013.03.172. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.

Preclinical evaluation of carbon-11 and fluorine-18 sulfonamide derivatives for in vivo radiolabeling of erythrocytes.

BackgroundTo date, few PET tracers for in vivo labeling of red blood cells (RBCs) are available. In this study, we report the radiosynthesis and in vitro and in vivo evaluation of 11C and 18F sulfonamide derivatives targeting carbonic anhydrase II (CA II), a metallo-enzyme expressed in RBCs, as potential blood pool tracers. A proof-of-concept in vivo imaging study was performed to demonstrate the feasibility to assess cardiac function and volumes using electrocardiogram (ECG)-gated positron emission tomography (PET) acquisition in comparison with cine magnetic resonance imaging (cMRI) in rats and a pig model of myocardial infarction.MethodsThe inhibition constants (Ki) of CA II were determined in vitro for the different compounds by assaying CA-catalyzed CO2 hydration activity. Binding to human RBCs was estimated after in vitro incubation of the compounds with whole blood. Biodistribution studies were performed to evaluate tracer kinetics in NMRI mice. ECG-gated PET acquisition was performed in Wistar rats at rest and during pharmacological stress by infusing dobutamine at 10 μg/kg/min and in a pig model of myocardial infarction. Left ventricular ejection fraction (LVEF) and volumes were compared with values from cMRI.ResultsThe Ki of the investigated compounds for human CA II was found to be in the range of 8 to 422 nM. The fraction of radioactivity associated with RBCs was found to be ≥90% at 10- and 60-min incubation of tracers with heparinized human blood at room temperature for all tracers studied. Biodistribution studies in mice indicated that 30% to 67% of the injected dose was retained in the blood pool at 60 min post injection. A rapid and sustained tracer uptake in the heart region with an average standardized uptake value of 2.5 was observed from micro-PET images. The LVEF values obtained after pharmacological stress in rats closely matched between the cMRI and micro-PET values, whereas at rest, a larger variation between LVEF values obtained by both techniques was observed. In the pig model, a good agreement was observed between PET and MRI for quantification of left ventricular volumes and ejection fraction.ConclusionsThe 11C and 18F sulfonamide derivatives can be used for efficient in vivo radiolabeling of RBCs, and proof-of-concept in vivo imaging studies have shown the feasibility and potential of these novel tracers to assess cardiac function.

Quantification of Left Ventricular Size and Function Using Contrast-Enhanced Real-Time 3D Imaging with Power Modulation: Comparison with Cardiac MRI

In patients with optimal images, real-time 3-D echocardiography (RT3DE) allows accurate evaluation of left ventricular (LV) volumes and ejection fraction (EF). However, in patients with poor acoustic windows, lower correlations were reported despite the use of contrast. We hypothesized that power modulation (PM) RT3DE imaging that uses low mechanical indices and provides uniform LV opacification could overcome this problem. Accordingly, we sought to: (i) Test the feasibility of quantification of LV volumes and EF from contrast-enhanced (CE) PM RT3DE images, (ii) validate this technique against cardiac magnetic resonance (CMR) reference and (iii) test its clinical value by quantifying the improvement in accuracy and reproducibility. We studied 20 patients who underwent CMR, harmonic nonenhanced RT3DE and CE PM RT3DE imaging on the same day. All images were analyzed to obtain end-systolic and end-diastolic LV volumes (EDV, ESV) and calculate EF. To determine the reproducibility of each RT3DE technique, imaging was repeated in the same setting by a second sonographer. In addition, patients were divided according to the quality of their RT3DE images into two groups, for which agreement with CMR and reproducibility were calculated separately. CE PM RT3DE imaging improved the accuracy of EDV, ESV and EF measurements in patients with poor acoustic windows without significantly affecting those in patients with optimal images. In addition, CE PM RT3DE imaging improved the reproducibility of the measurements, as reflected by a twofold decrease in intermeasurement variability. Importantly, the variability in CE PM RT3DE–derived volumes and EF was under 10%, irrespective of image quality. This methodology may become the new standard for LV size and function, which will be particularly important in patients with poor acoustic windows or contraindications to CMR.

Evaluation of fetal left ventricular volume with spatiotemporal image correlation(STIC)

Objective To investigate the feasibility of spatiotemporal image correlation(STIC)to assess left ventricular volume in normal fetuses.Methods The volume data acquisition of 162 normal fetuses ranging between 22 and 38 weeks of gestation was achieved by automatic sweep scan.The virtual organ computer-aided analysis(VOCAL Ⅱ)was then used to evaluate end-systolic and end-diastolic volumes of left ventricle and compared with that obtained by M-mode Teichholz formula and 2D biplane Simpson's method.Results Twenty-six fetuses with poor STIC image and 2 twin pregnancies were excluded,the study subjects consisted of 134 singleton fetuses.The highest concordance correlation(r =0.968,for EDV,r =0.956 for ESV;P =0.000)was noted between 2D biplane Simpson' s and STIC VOCAL Ⅱ values with a small bias(0.282 ml for EDV,0.117 ml for ESV).The Bland-Altman analysis showed that STIC VOCAL Ⅱ had the best agreement than M-mode Teichholz formula and 2D biplane Simpson's method.The result showed that there were significant difference between Mmode Teichholz formula and Simpson's method in EDV and ESV(P＜0.05).There were significant differences between M-mode Teichholz formula and STIC VOCAL Ⅱ(P＜0.05).There were no significant differences between STIC VOCAL Ⅱ and Simpson' s method in EDV and ESV.Conclusions There is a good agreement between left ventricular volumes measured either by STIC VOCAL Ⅱ or by 2D biplane Simpson's method.STIC is a novel technique that can be more accurate than conventional Methods in quantification of fetal left ventricular volumes.All the volume data acquisition is achieved by postprocessing facilities.STIC promises to become a new method for left ventricular volume quantification. Key words: Echocardiography; Fetus; Ventricular function,left; Ventricular volume,left; Spatiotemporal image correlation

Real Time Three‐Dimensional Echocardiographic Assessment of Left Ventricular Function in Heart Failure Patients: Underestimation of Left Ventricular Volume Increases with the Degree of Dilatation

Accurate quantification of left ventricular (LV) volumes and ejection fraction (EF) is of critical importance. Cardiac magnetic resonance (CMR) is considered as the reference and three-dimensional echocardiography (3DE) is an accurate method, but only few data are available in heart failure patients. We therefore sought to compare the accuracy of real time three-dimensional echocardiography (RT3DE) and two-dimensional echocardiography (2DE) for quantification of LV volumes and EF, relative to CMR imaging in an unselected population of heart failure patients. We studied 24 patients (17 men, age 58 ± 15 years) with history of heart failure who underwent echocardiographic assessment of LV function (2DE, RT3DE) and CMR within a period of 24 hours. Mean LV end-diastolic volume (LVEDV) was 208 ± 109 mL (121 ± 64 mL/m(2) ) and mean LVEF was 31 ± 12.8%. 3DE data sets correlate well with CMR, particularly with respect to the EF (r: 0.8, 0.86, and 0.95; P < 0.0001 for LVEDV, LVESV, and EF, respectively) with small biases (-55 mL, -44 mL, 1.1%) and acceptable limits of agreement. RT3DE provides more accurate measurements of LVEF than 2DE (z= 2.1, P = 0.037) and lower variability. However, 3DE-derived LV volumes are significantly underestimated in patients with severe LV dilatation. In patients with LVEDV below 120 mL/m(2) , RT3DE is more accurate for volumes and EF evaluation. Compared with CMR, RT3DE is accurate for evaluation of EF and feasible in all our heart failure patients, at the expense of a significant underestimation of LV volumes, particularly when LVEDV is above 120 mL/m(2) .

Comparison between three-dimensional speckle-tracking echocardiography and cardiac magnetic resonance imaging for quantification of left ventricular volumes and function

We evaluated the accuracy of three-dimensional speckle-tracking echocardiography (3DSTE) to evaluate left ventricular (LV) volumes, ejection fraction (EF), and global circumferential strain (CS) in comparison with cardiac magnetic resonance imaging (MRI) in a healthy population. A total of 45 out of 50 consecutive healthy subjects (38 males, age 45 ± 15 years) successfully underwent both 3DSTE and MRI on the same day. Three-dimensional echocardiography data sets were analysed using speckle tracking to measure LV end-diastolic and end-systolic volumes, EF, and global CS. With MRI, the method of discs approximation was used to obtain volumes and the EF, whereas CS was acquired using myocardial tissue tagging. Inter-technique comparisons included regression and the Bland-Altman analysis. For quantification of LV volumes, 3DSTE correlated well with MRI (r: 0.75-0.81), but volumes were significantly underestimated with relatively large biases (13-34 mL) and wide limits of agreement (SD: 11-25 mL). However, excellent accuracy was revealed for measurement of EF by 3DSTE with a good correlation (r: 0.91), minimal bias, and narrow limits of agreement (0.6 ± 1.7%) compared with MRI. For measurement of CS, a large mean bias was found between techniques (10.0%), despite narrow limits of agreement (SD: 1.7%) and a good correlation between techniques (r: 0.80). Although 3DSTE-derived LV volumes are underestimated in most patients compared with MRI, measurement of the LVEF revealed excellent accuracy. Measurements of CS were systematically greater (i.e. more negative) with 3DSTE than MRI, which likely reflects various inter-technique differences that preclude direct comparability of their measurements.

Geometrical models for cardiac MRI in rodents: comparison of quantification of left ventricular volumes and function by various geometrical models with a full-volume MRI data set in rodents

MRI has been proven to be an accurate method for noninvasive assessment of cardiac function. One of the current limitations of cardiac MRI is that it is time consuming. Therefore, various geometrical models are used, which can reduce scan and postprocessing time. It is unclear how appropriate their use is in rodents. Left ventricular (LV) volumes and ejection fraction (EF) were quantified based on 7.0 Tesla cine-MRI in 12 wild-type (WT) mice, 12 adipose triglyceride lipase knockout (ATGL(-/-)) mice (model of impaired cardiac function), and 11 rats in which we induced cardiac ischemia. The LV volumes and function were either assessed with parallel short-axis slices covering the full volume of the left ventricle (FV, gold standard) or with various geometrical models [modified Simpson rule (SR), biplane ellipsoid (BP), hemisphere cylinder (HC), single-plane ellipsoid (SP), and modified Teichholz Formula (TF)]. Reproducibility of the different models was tested and results were correlated with the gold standard (FV). All models and the FV data set provided reproducible results for the LV volumes and EF, with interclass correlation coefficients ≥0.87. All models significantly over- or underestimated EF, except for SR. Good correlation was found for all volumes and EF for the SR model compared with the FV data set (R(2) ranged between 0.59-0.95 for all parameters). The HC model and BP model also predicted EF well (R(2) ≥ 0.85), although proved to be less useful for quantitative analysis. The SP and TF models correlated poorly with the FV data set (R(2) ≥ 0.45 for EF and R(2) ≥ 0.29 for EF, respectively). For the reduction in acquisition and postprocessing time, only the SR model proved to be a valuable method for calculating LV volumes, stroke volume, and EF.

Development and validation of a new automatic algorithm for quantification of left ventricular volumes and function in gated myocardial perfusion SPECT using cardiac magnetic resonance as reference standard

BackgroundBy gating image acquisition in myocardial perfusion SPECT (MPS) to ECG, left ventricular (LV) volumes and function can be determined. Several previous studies have shown that existing MPS software packages underestimate LV volumes compared to cardiac magnetic resonance (CMR). The aim of this study was therefore to develop a new LV segmentation algorithm for gated MPS using CMR as reference standard. Methods and ResultsA total of 126 patients with suspected coronary artery disease, who underwent both gated MPS and CMR were retrospectively included. The proposed LV segmentation algorithm (Segment) was trained in 26 patients, and tested in 100 patients in comparison to four commercially available MPS software packages (QGS, MyoMetrix, ECTb, and Exini) using CMR as reference standard. Mean bias ± SD between MPS and CMR was for EDV −5% ± 12%, −43% ± 8%, −40% ± 8%, −42% ± 9%, −32% ± 7%, for ESV 0% ± 17%, −41% ± 16%, −34% ± 15%, −54% ± 13%, −41% ± 10%, for EF −2% ± 13%, −1% ± 14%, −7% ± 15%, 17% ± 16%, 10% ± 17% for Segment, QGS, MyoMetrix, ECTb, and Exini, respectively, and for LVM 3% ± 18%, 33% ± 25%, 37% ± 24% for Segment, QGS, and ECTb, respectively. Correlation between MPS by Segment and CMR were for EDV R2 = 0.89, for ESV R2 = 0.92, for EF R2 = 0.69, and for LVM R2 = 0.72, with no difference compared to the correlation between the other MPS software packages and CMR (EDV R2 = 0.86-0.92, ESV R2 = 0.91-0.93, EF R2 = 0.64-0.65, and LVM R2 = 0.68-0.70). ConclusionThe Segment software quantifies LV volumes and EF by MPS with similar correlation and a low bias compared to other MPS software packages, using CMR as reference standard. Hence, the Segment software shows potential to provide clinically relevant volumes and functional values from MPS.