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

• Published in: Archives of cardiovascular diseases 2017-11, Vol.110 (11), p.580-589
• Main Authors: Levy, Franck, Dan Schouver, Elie, Iacuzio, Laura, Civaia, Filippo, Rusek, Stephane, Dommerc, Carinne, Marechaux, Sylvestre, Dor, Vincent, Tribouilloy, Christophe, Dreyfus, Gilles
• Format: Article
• Language: English
• Subjects: 3 tesla cardiac magnetic resonance; 3D echocardiography; Aged; Automation; Cardiovascular; Echocardiographie tridimensionnelle; Echocardiography, Three-Dimensional - methods; Feasibility Studies; Female; Heartmodel; HeartModelA.I; Humans; Image Interpretation, Computer-Assisted; Internal Medicine; IRM cardiaque 3 tesla; Life Sciences; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Predictive Value of Tests; Prospective Studies; Reproducibility of Results; Software; Stroke Volume; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Ventricular Function, Left
• ISSN: 1875-2136; 1875-2128
• DOI: 10.1016/j.acvd.2016.12.015

Summary Background 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. Aims 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. Methods Sixty-three consecutive patients, who had comprehensive 3D TTE and CMR examinations within 24 hours, were eligible for inclusion. Nine patients (14%) were excluded because of insufficient echogenicity in the 3D TTE. Thus, 54 patients (40 men; mean age 63 ± 13 years) were prospectively included into the study. Results The inter- and intraobserver reproducibilities of 3D TTE 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 ± 34 mL; 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 3D TTE and CMR for ESV and LVEF were excellent ( r = 0.93 and r = 0.91, respectively; P < 0.0001). Conclusion 3D TTE 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.