Real-time Three-dimensional Echocardiography In Patients Research Articles

Diagnostic Accuracy of Transillumination in Mitral Valve Prolapse: Side-by-Side Comparison of Standard Transthoracic Three-Dimensional Echocardiography against Surgical Findings

In patients with mitral valve prolapse (MVP) eligible for surgery, three-dimensional echocardiographic (3DE) imaging is routinely used for preoperative assessment. 1 Baumgartner H. Falk V. Bax J.J. De Bonis M. Hamm C. Holm P.J. et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017; 38: 2739-2791 Crossref PubMed Scopus (2) Google Scholar ,2 Nishimura R.A. Otto C.M. Bonow R.O. Carabello B.A. Erwin J.P. Fleisher L.A. et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017; 70: 252-289 Crossref PubMed Scopus (1731) Google Scholar Despite the worldwide use of transesophageal echocardiography in this context, transthoracic echocardiographic (TTE) imaging allows accurate noninvasive evaluation of mitral valve (MV) anatomy and pathology. 3 Gripari P. Mapelli M. Bellacosa I. Piazzese C. Milo M. Fusini L. et al. Transthoracic echocardiography in patients undergoing mitral valve repair: comparison of new transthoracic 3D techniques to 2D transoesophageal echocardiography in the localization of mitral valve prolapse. Int J Cardiovasc Imaging. 2018; 34: 1099-1107 Crossref PubMed Scopus (10) Google Scholar , 4 Tamborini G. Muratori M. Maltagliati A. Galli C.A. Naliato M. Zanobini M. et al. Pre-operative transthoracic real-time three-dimensional echocardiography in patients undergoing mitral valve repair: accuracy in cases with simple vs. complex prolapse lesions. Eur J Echocardiogr. 2010; 11: 778-785 Crossref PubMed Scopus (43) Google Scholar , 5 Pepi M. Tamborini G. Maltagliati A. Galli C.A. Sisillo E. Salvi L. et al. Head-to-head comparison of two- and three-dimensional transthoracic and transesophageal echocardiography in the localization of mitral valve prolapse. J Am Coll Cardiol. 2006; 48: 2524-2530 Crossref PubMed Scopus (196) Google Scholar Transillumination (TI) is a new three-dimensional tool that improves the visualization of cardiac structures due to shadow effects achieved by the use of a virtual light source. 6 Genovese D. Addetia K. Kebed K. Kruse E. Yamat M. Narang A. et al. First clinical experience with 3-dimensional echocardiographic transillumination rendering. JACC Cardiovasc Imaging. 2019; 12: 1868-1871 Crossref PubMed Scopus (20) Google Scholar We aimed to compare the diagnostic accuracy of TTE TI side by side with standard 3DE (s3DE) display in patients undergoing surgery for MVP. Surgical valve inspection was used as a reference standard, even though surgery allows only static MV assessment. 3 Gripari P. Mapelli M. Bellacosa I. Piazzese C. Milo M. Fusini L. et al. Transthoracic echocardiography in patients undergoing mitral valve repair: comparison of new transthoracic 3D techniques to 2D transoesophageal echocardiography in the localization of mitral valve prolapse. Int J Cardiovasc Imaging. 2018; 34: 1099-1107 Crossref PubMed Scopus (10) Google Scholar , 4 Tamborini G. Muratori M. Maltagliati A. Galli C.A. Naliato M. Zanobini M. et al. Pre-operative transthoracic real-time three-dimensional echocardiography in patients undergoing mitral valve repair: accuracy in cases with simple vs. complex prolapse lesions. Eur J Echocardiogr. 2010; 11: 778-785 Crossref PubMed Scopus (43) Google Scholar , 5 Pepi M. Tamborini G. Maltagliati A. Galli C.A. Sisillo E. Salvi L. et al. Head-to-head comparison of two- and three-dimensional transthoracic and transesophageal echocardiography in the localization of mitral valve prolapse. J Am Coll Cardiol. 2006; 48: 2524-2530 Crossref PubMed Scopus (196) Google Scholar

Evaluation of right atrial volumes and functions by real-time three-dimensional echocardiography in patients after acute inferior myocardial infarction.

Right ventricle (RV) involvement causes acute systolic and diastolic functional alterations in the RV in patients after inferior myocardial infarction (IMI), which may result in an increase in left ventricle (LV) end-diastolic and right atrial (RA) pressure. In our study, we sought to evaluate RA volumes and mechanical functions using real-time three-dimensional echocardiography (RT3DE) in IMI patients with or without RV involvement. Ninety-six consecutive patients with IMI (mean age: 59.7±10.2years, 60 female) were included. RV myocardial involvement (RVMI) was defined as the presence of a culprit lesion at the proximal portion of the first RV marginal branch in coronary angiography. The study population was divided into two groups: IMI (58.3%) and IMI+RVMI (41.7%). Patients were evaluated using conventional two-dimensional echocardiography (2DE) and RT3DE. In RT3DE measurements, IMI+RVMI patients had significantly higher RA phasic volumes and worse conduit mechanical function. A receiver operating characteristic (ROC) curve analysis revealed that an RT3DE RA maximum volume (Vmax) index>27.9mL/m2 was an independent predictor of RV involvement in patients after acute IMI, with a sensitivity of 80.0% and a specificity of 89.3%. Right ventricle involvement may cause an increase in RA phasic volumes and deterioration of conduit function in patients with acute IMI.

Assessment of right ventricular geometry and function from real time three-dimensional echocardiography in patients with acute decompensated heart failure and implanted intracardiac devices

This study was designed to compare two methods for quantifying right ventricular (RV) geometry and function obtained from real-time three-dimensional echocardiography in patients with acute decompensated heart failure and implanted intracardiac devices. 42 patients (29 men and 13 women) aged 29 to 78 years with acute heart failure were included into the research. Three-dimensional reconstruction RT-4DE Tom Tec revealed several advantages in determining the volume and right ventricular function in comparison with 4-D LV Echo PAC program in cases of complicated geometry of endocardial contour of the right ventricle.

Assessment of left atrial volume and mechanical functions using real-time three-dimensional echocardiography in patients with mitral annular calcification.

Objective:Mitral annular calcification (MAC) is degeneration of the fibrous annular ring of the mitral valve. Left atrial (LA) function and volume have been evaluated by many methods; however, none have used real-time three-dimensional echocardiography (RT3DE) in patients with MAC. Our study is the first to evaluate LA volume and mechanical function using RT3DE in patients with MAC.Methods:Our study was a prospective cross-sectional study. In total, 32 patients with echocardiographic evidence of MAC and 30 volunteers without MAC were enrolled in the study. Kolmogorov–Smirnov test, Student’s t-test, Mann-Whitney U test, chi-square test, Pearson’s correlation test, and multiple linear regression analyses were used in this study.Results:LA diameter was significantly higher in patients with MAC (38.5±3.8 vs. 31.1±2.9, p<0.001). Maximum LA volume (49.6±11.2 vs. 35.6±2.5, p<0.001), minimum LA volume (23.8±7.9 vs. 12.6±2.3, p<0.001), and LA volume index (LAVI) (26.9±6.1 vs. 20.5±2.4, p<0.001) were also higher in the MAC group. LAVI was correlated with age (p<0.001), blood urea nitrogen levels (p=0.089), total cholesterol levels (p=0.055), left ventricular systolic myocardial velocity (p=0.048), E/A ratio (p<0.001), and MAC (p<0.001). Multiple linear regression analyses revealed that age (β=0.390, p<0.001) and MAC (β=0.527, p<0.001) were independent predictors of LAVI.Conclusion:We found that LA mechanical function was impaired in patients with MAC. Furthermore, age and MAC were independent predictors of increased LAVI according to our RT3DE examination.

Assessment of left ventricular volume and functions by real-time three-dimensional echocardiography in patients with compensated and decompensated heart failure

The aim of the study was to evaluate congestive heart failure (HF) patients with real-time three-dimensional echocardiography (3DE) to investigate why some of them present with acute decompensation despite having two-dimensional echocardiographic (2DE) parameters with compensated HF patients. The study population consisted of 36 patients with decompensated HF (24 males, 12 females; mean age 65.8±10.4 years) and 30 patients with compensated HF (21 males, 9 females; mean age 63.2±11.5 years).The levels of pro-brain natriuretic peptide (pro-BNP), serum electrolytes, renal function tests and complete blood counts were determined. All patients underwent 2DE and 3DE evaluations. Heart rate and blood urea nitrogen levels were higher in patients with decompensated HF than those with compensated HF (95.8±21.4 vs. 81.2±14.9, p=0.002; 28.3±15.7 mg/dl vs. 18±6.8 mg/dl, p=0.001, respectively). Pro-BNP levels and NYHA class were significantly higher in patients with decompensated heart failure [4925 pg/ml (2199-8711) vs. 330 pg/ml (197-756), p<0.0001 and 2.3±0.6 vs. 1.2±0.4, p<0.0001, respectively]. Although 2DE parameters were similar between groups, left ventricular ejection fraction was lower in patients with decompensated HF while end-diastolic and end-systolic volumes by 3DE were significantly higher in the same group (26.3±3.8% vs. 30.3±4.0%; 205.6±55.5 ml vs. 145.0±33.7 ml; 178.4±55.6 ml vs. 115.7±32.5 ml, all p<0.0001, respectively). However, systolic volume was higher in patients with compensated HF (52.0±15.5 ml vs. 62±12 ml, p=0.005). We think that 3DE provides more reliable information about left ventricular volume and functions in the evaluation of patients with HF.

Assessment of Left Ventricular Volume and Functions by Real-Time Three-Dimensional Echocardiography in Patients with Compensated and Decompensated Heart Failure

Assessment of Left Ventricular Volume and Functions by Real-Time Three-Dimensional Echocardiography in Patients with Compensated and Decompensated Heart Failure

Evaluation of left and right ventricular function by real-time three-dimensional echocardiography in patients with heart transplantation

Objective To evaluate left and right ventricular function by real-time three-dimensional echocardiography in patients with heart transplantation.Methods Fourteen patients with heart transplantation ( rejection)[12 male,2 female,mean age (49.21±17.91)],twenty four patients with heart transplantation (no rejection) [21 male,3 female,mean age (40.11±12.57)],and fifty one subjects with normal left ventricular function [26 male,25 female,mean age (43.69±14.81) ] were examined by Philips iE33 with a X3-1 probe.Results Right ventricular stroke volume (RVSV) and right ventricular ejection fraction (RVEF) in heart transplantation (including no rejection and rejection) was reduced compared with subjects with normal heart function (all P 0.05),but the volume and function of right ventricle were no significantly different between rejection heart transplantation and no rejection heart transplantation.Parameter index of 17 segment including standard deviation (SD) and maximum difference(Dif) of 16,12 and 6 segment time to minimal systolic volume(Tmsv 16-SD,Tmsv 16-Dif,Tmsv 12-SD,Tmsv 12-Dif,Tmsv 6-SD,Tmsv 6-Dif),and the percent of SD and maximum difference 16,12 and 6 segment time tominimal systolic volume [Tmsv 16-SD(%),Tmsv 16-Dif(%),Tmsv 12-SD(%),Tmsv 12-Dif(%),Tmsv 6-SD(%),Tmsv 6-Dif(%)] was significantly higher in patients with heart transplantation (rejection) than that in subjects with normal heart function and in patients with heart transplantation (no rejection)[except Tmsv 16-SD and Tmsv 16-SD(%),other P 0.05).But also average,maximum and minimum value of excursion in three groups was no significantly different (all P>0.05).Conclusions Real-time three-dimensional echocardiography can rapidly and acurately evaluate left and right ventricular function in patients with heart transplantation. Key words: Echocardiography,real-time three-dimensional; Heart transplant; Ventricular function

Value of real-time three-dimensional echocardiography in patients with restrictive cardiomyopathy and constrictive pericardits

Objective To investigate value of real-time three-dimensional echocardiography timingexcursion parametric index and 17 segment volume curves index in patients with restrictive cardiomyopathy and constrictive pericardits.Methods Seventeen patients with restrictive cardiomyopathy (proven by biopsy) ,six patients with constrictive pericardits (proven by CT or surgical),twenty subjects with normal left ventricular(LV) function were examined by Philips iE33 with X3-1 probe.Results Parameter index of Tmsv 16-SD,Tmsv 12-SD Tmsv 6-SD,Tmsv 16-Dif,Tmsv 12-Dif,Tmsv 6-Dif,Tmsv 16-SD(%) ,Tmsv 12-SD(%),Tmsv 6-SD(%),Tmsv 16-Dif(%),Tmsv 12-Dif(%),Tmsv 6-Dif(%) was significantly higher in patients with restrictive cardiomyopathy than that in subjects with normal LV function(all P ＜0.05).Average and maximum value and minimum of excursion was significantly lower in patients with restrictive cardiomyopathy than that in subjects with normal LV function (all P ＜0.005).Whereas,compare with subjects with normal LV function,the parametric indexes of timing-excursion and 17 segment volume curves were not significantly difference in patients with constrictive pericardits(all P ＞0.05).Conclusions Realtime three-dimensional echocardiography can evaluate and diagnose fastly restrictive cardiomyopathy and constrictive pericardits. Key words: Echocardiography,real-time three-dimensional; Cardiomyopathy,restrictive; Pericardits,constrictive

Test-Retest Variability of Volumetric Right Ventricular Measurements Using Real-Time Three-Dimensional Echocardiography

Substantial variability in sequential echocardiographic right ventricular (RV) quantification may exist. Interobserver and intraobserver values are well known, but acquisition (test-retest) variability has been rarely assessed. The objective of this study was to determine the test-retest variability of sequential RV volume and ejection fraction (EF) measurements by real-time three-dimensional echocardiography in patients with congenital heart disease and healthy controls. Twenty-eight participants (21 patients with congenital heart disease, seven healthy controls; mean age, 30 ± 14 years; 43% men) underwent a series of three echocardiographic studies. To obtain interobserver and intraobserver test-retest variability, two sonographers acquired sequential RV data sets in each participant during one outpatient visit. RV volumetric quantification was done using semiautomated three-dimensional border detection. The variability data were analyzed using correlation coefficients, Bland-Altman analysis, and coefficients of variation. Absolute mean differences for sequential intraobserver acquisitions were 12 ± 12 mL for end-diastolic volume, 7 ± 6 mL for end-systolic volume, and 4 ± 3% for EF. Interobserver and intraobserver test-retest variability, respectively, were 7% and 7% for RV end-diastolic volume, 14% and 7% for end-systolic volume, and 8% and 6% for EF. Good test-retest variability, besides the practical nature of real-time three-dimensional echocardiography for RV volume and EF assessment, makes it a valuable technique for serial follow-up. Although it may be challenging to diminish all factors that can influence echocardiographic examination for serial follow-up, standardization of RV size and functional measurements should be a goal to produce more interchangeable data.

Pre-operative transthoracic real-time three-dimensional echocardiography in patients undergoing mitral valve repair: accuracy in cases with simple vs. complex prolapse lesions

The aim of this study, undertaken in patients who underwent mitral valve (MV) repair surgery, was to evaluate the accuracy of pre-operative three-dimensional (3D) transthoracic echocardiography (TTE) in the evaluation of MV pathology in cases with simple or complex lesions. Two hundred consecutive patients with severe mitral regurgitation due to degenerative MV prolapse underwent a complete 3DTTE the day before surgery. Three-dimensional TTE data were compared with MV surgical inspection. Three-dimensional echocardiography was feasible in a relatively short time (5 ± 3 min) with good (67%) and optimal (21%) imaging quality in the majority of cases. Three-dimensional TTE allowed an accurate identification (95% accuracy) of all MV lesions. Seventy-three (36.5%) patients had simple lesions at 3DTTE and 71 of them (97.2%) underwent a simple surgical procedure; 127 (63.5%) had complex lesions at 3DTTE and, in these cases, surgeons performed either simple procedures (48%) or complex procedures (47.2%) or valve replacement in 4.7% (after a first attempt for repair). Three-dimensional TTE is feasible, not time-consuming, and accurate in identifying cases with simple vs. complex MV lesions.

The application value of real-time three-dimensional echocardiography in patients with restrictive cardiomyopathy

Objective To investigate the value of real-time three-dimensional echocardiography timing-excursion parametric index and 17 segment volume curves index in patients with restrictive cardiomyopathy.Methods Eight patients with restrictive cardiomyopathy (proven by biopsy),twenty eight subjects with normal left ventricular(LV) function were examined by Philips iE33 with X3-1 probe.Results Parameter index of the SD and maximum difference of Tmsv of 16 segments,12 segments,and 6 basal segments(Tmax 16SD,Tmsv-12SD Tmsv -6SD,Tmsv-16Dif,Tmsv-12 Dif,Tmsv-6Dif,Tmsv 16-SD%,Tmsv 12-SD%,Tmsv 6-SD%,Tmsv 16-Dif%,Tmsv 12-Dif%,Tmsv 6-Dif%) was significantly higher in patients with restrictive cardiomyopathy than that in subjects with normal LV function(all P＜0.001).Average and maximum value and minimum of excursion was significantly lower in patients with restrictive cardiomyopathy than that in subjects with normal LV function(P＜0.001,P＜0.005,P＜0.005).And parameter index of 17 segment volume curves index showed higher sensitivity,specificity,positive predictive value and negative predictive value for diagnose restrictive cardiomyopathy.Conclusions Real-time threedimensional echocardiography can evaluate and diagnose restrictive cardiomyopathy fastly. Key words: Echocardiography; real-time three-dimensional; Cardiomyopathy; restrictive; Ventricular function; left

Comparison of Left Atrial Volumes and Function by Real-Time Three-Dimensional Echocardiography in Patients Having Catheter Ablation for Atrial Fibrillation With Persistence of Sinus Rhythm Versus Recurrent Atrial Fibrillation Three Months Later

Real-time 3-dimensional echocardiography (RT3DE) can provide a unique combination of accurate left atrial (LA) volume quantification and rapid, automatic assessment of LA function. The aim of the study was to evaluate the changes in LA volumes and function in patients with atrial fibrillation (AF) undergoing radiofrequency catheter ablation (RFCA) using RT3DE; 57 consecutive patients referred for RFCA were studied. Paroxysmal AF was present in 43 patients (75%) and persistent AF in 14 (25%). After a mean follow-up of 7.9 +/- 2.7 months, patients were divided into 2 groups: successful RFCA (SR group) and recurrence of AF (AF group). RT3DE was performed before, within 3 days, and 3 months after RFCA to assess LA volumes (maximum, minimum, and preA) and LA functions (passive, active, and reservoir). A total of 38 patients (67%) had successful RFCA (SR group). Immediately after RFCA, no significant changes in LA volumes and function were observed. After 3 months, a significant reduction in LA volumes (maximum: 26 +/- 8 to 23 +/- 7 ml/m(2), p <0.01) was noted only in the SR group, with a significant improvement in LA active (22 +/- 8% to 33 +/- 9%, p <0.01) and reservoir functions (116 +/- 45% to 152 +/- 54%, p <0.01). Conversely, the AF group showed a trend towards a deterioration of LA volumes and function. In conclusion, in patients who maintain sinus rhythm after RFCA, a significant reverse remodeling and functional improvement of the left atrium is observed using RT3DE.

3D Echocardiography: A Review of the Current Status and Future Directions

Ultrasound technology has improved markedly in the past 10 to 15 years, prompting echocardiographers to extend its use in studying cardiac structure and function. New ultrasound equipment and techniques offer superior image quality, greater accuracy, and expanding capabilities. As a result, more and improved imaging modalities are available for evaluating cardiac anatomy, ventricular function, blood flow velocity, and valvular diseases. Threedimensional (3D) echocardiography offers the ability to improve and expand the diagnostic capabilities of cardiac ultrasound. However, as with any emerging technology, the enthusiasm to embrace a new technique must be tempered by a critical appraisal of the evidence supporting its use. It is essential to assess the limitations as well as the unique capabilities it provides. Cardiac imaging should be safe, accurate, versatile, comprehensive, and cost-effective, while providing important clinical information. Criteria for appropriate utilization should be based on current evidence and updated as new information becomes available. To justify the use of a new 3D modality, its unique contribution to clinical practice must be critically analyzed. In this article we review the status of 3D echocardiography, examine the evidence for its use in various clinical situations, and propose guidelines for appropriate application of this technique based on available evidence.

Value of Mitral Valve Tenting Volume Determined by Real-Time Three-Dimensional Echocardiography in Patients With Functional Mitral Regurgitation

This study sought to evaluate mitral valve tenting volume (TnV) as a clinical parameter using real-time 3-dimensional echocardiography in patients with functional mitral regurgitation (MR). In 27 patients with functional MR and 4 controls without mitral disease, real-time 3-dimensional echocardiographic images were obtained to measure TnV frame by frame from presystole to end-systole. The maximal and minimal TnVs during systole were identified in each patient, and mitral annular areas and tenting heights were also measured. Using 2-dimensional echocardiography, tenting area (TnA) was measured from the apical long-axis, apical 4-chamber, and apical 2-chamber views. The regurgitant orifice area was measured by the proximal isovelocity surface area method. Maximal and minimal TnVs occurred at the time of 2 +/- 6% and 78 +/- 6% of whole systolic duration, respectively, and the systolic percentage change of TnV was related to that of tenting height but not to that of mitral annular area. TnA on the long-axis images was significantly larger than that on the 4- and 2-chamber images (2.5 +/- 1.4 vs 1.7 +/- 1.3 and 1.9 +/- 1.4 cm(2), respectively, p <0.001). Regurgitant orifice area was significantly correlated with maximal TnV (r = 0.90), minimal TnV (r = 0.86), and TnA on the long-axis (r = 0.79), 4-chamber (r = 0.75), and 2-chamber (r = 0.73) images. Among minimal TnV and 3 TnAs, minimal TnV was the only independent determinant of regurgitant orifice area (p <0.001). Minimal TnV >or=3.90 ml identified significant functional MR with a sensitivity of 86% and a specificity of 100%. In conclusion, TnV derived from real-time 3-dimensional echocardiography is a preferable novel single index for assessing mitral valve tethering in functional MR to TnA that is dependent on the location of 2-dimensional planes.

Assessment of left ventricular systolic synchronicity by real-time three-dimensional echocardiography in patients with dilated cardiomyopathy

Recent advances in real-time three-dimensional echocardiography (RT3DE) offer the potential to assess the left ventricular (LV) dyssynchrony simultaneously by analyzing the 17 segments time-volume curves. The purpose of this study was to test the feasibility and accuracy of RT3DE for quantitative evaluation of left ventricular systolic synchronicity. Twenty-four patients with dilated cardiomyopathy (DCM) and twenty-five healthy volunteers were enrolled in this study. Full volume RT3DE was performed by using Philips IE33 with X3-1 probe. The global and 17-segmental time-volume curves were obtained by the on-line Qlab software (version 4.2). The time to minimal systolic volume in each segment (T(msv)) was taken to derive the following indexes of systolic asynchrony: T(msv) 16-SD, T(msv) 16-Dif, T(msv) 12-SD, T(msv) 12-Dif, T(msv) 6-SD and T(msv) 6-Dif, which meant the standard deviation or the maximal difference of T(msv) among the 16, 12 and 6 segments of the left ventricle respectively. The software also provided with each of the above parameters as a percentage of the cardiac cycle. T(msv) 16-SD, T(msv) 12-SD and T(msv) 6-SD were all significantly larger in the DCM group than those of the control group [T(msv) 16-SD: (52.9 +/- 40.6) ms vs (8.8 +/- 6.2) ms; T(msv) 12-SD: (29.5 +/- 30.8) ms vs (6.9 +/- 4.0) ms; T(msv) 6-SD: (28.9 +/- 34.6) ms vs (7.0 +/- 4.7) ms, all P < or = 0.001]. T(msv) 16-Dif, T(msv) 12-Dif and T(msv) 6-Dif were also significantly larger in the DCM group. There were close negative relations between the LVEF determined by RT3DE and each of the indexes of systolic asynchrony, among which the indexes of T(msv)-16-SD% and T(msv)-16-Dif% correlated most closely (r = -0.703 and r = -0.701, respectively). The DCM patients had significantly larger EDV and ESV, with significantly reduced LVEF compared with the healthy subjects. RT3DE provides a simple, useful and unique approach to assess the systolic synchronicity of all the left ventricular segments simultaneously.

2272: Assessment of left ventricular systolic synchronicity by real-time three-dimensional echocardiography in patients with dilated cardiomyopathy

2272: Assessment of left ventricular systolic synchronicity by real-time three-dimensional echocardiography in patients with dilated cardiomyopathy

The application of real-time three-dimensional echocardiography in patients with cardiovascular diseases

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Accuracy of measurement of left ventricular volume and ejection fraction by new real-time three-dimensional echocardiography in patients with wall motion abnormalities secondary to myocardial infarction

Three-dimensional echocardiography is an ideal tool for the measurement of left ventricular (LV) volume because no geometric assumptions about LV shape are needed. The introduction of new real-time 3-dimensional echocardiography (RT3DE) has allowed rapid acquisition of a 3-dimensional dataset with good image quality. The purpose of this study was to examine the accuracy of RT3DE for the measurement of LV volume and ejection fraction in patients with wall motion abnormalities by using quantitative gated single-photon emission computed tomography (QGSPECT) as a reference standard. The study population consisted of 25 consecutive patients with wall motion abnormalities who underwent LV volume measurement by 2-dimensional echocardiography and by QGSPECT. LV volume and ejection fraction by RT3DE were measured offline by using the average rotation method. In 23 of 25 patients (92%), it was possible to measure 3-dimensional volume with RT3DE. RT3DE correlated well with QGSPECT in the measurement of end-diastolic volume and end-systolic volume (r = 0.97, mean difference 3.4 ml; r = 0.98, mean difference 2.0 ml, respectively), 2-dimensional echocardiography also correlated with QGSPECT but underestimated LV volume (r = 0.98, mean difference 21.1 ml; r = 0.98, mean difference 15.6 ml, respectively). Ejection fraction obtained by RT3DE had better agreement with that obtained by QGSPECT than that obtained by 2-dimensional echocardiography (r = 0.92, mean difference -0.2%; r = 0.89, mean difference -2.7%, respectively). RT3DE allows convenient and accurate estimation of LV volume and ejection fraction in patients with wall motion abnormalities.

Initial clinical experience of real-time three-dimensional echocardiography in patients with ischemic and idiopathic dilated cardiomyopathy

The geometry of the left ventricle in patients with cardiomyopathy is often sub-optimal for 2-dimensional ultrasound when assessing left ventricular (LV) function and localized abnormalities such as a ventricular aneurysm. The aim of this study was to report the initial experience of real-time 3-D echocardiography for evaluating patients with cardiomyopathy. A total of 34 patients were evaluated with the real-time 3D method in the operating room (n = 15) and in the echocardiographic laboratory (n = 19). Thirteen of 28 patients with cardiomyopathy and 6 other subjects with normal LV function were evaluated by both real-time 3-D echocardiography and magnetic resonance imaging (MRI) for obtaining LV volumes and ejection fractions for comparison. There were close relations and agreements for LV volumes (r = 0.98, p <0.0001, mean difference = −15 ± 81 ml) and ejection fractions (r = 0.97, p <0.0001, mean difference = 0.001 ± 0.04) between the real-time 3D method and MRI when 3 cardiomyopathy cases with marked LV dilatation (LV end-diastolic volume >450 ml by MRI) were excluded. In these 3 patients, 3D echocardiography significantly underestimated the LV volumes due to difficulties with imaging the entire LV in a 60° × 60° pyramidal volume. The new real-time 3D echocardiography is feasible in patients with cardiomyopathy and may provide a faster and lower cost alternative to MRI for evaluating cardiac function in patients.