(Circulation. 1995;92:842-853.)
© 1995 American Heart Association, Inc.
Articles |
Assessment of Cardiac Function by Three-dimensional Echocardiography Compared With Conventional Noninvasive Methods
Presented in part at the 66th Scientific Sessions of the American Heart Association, Atlanta, Ga, November 8-11, 1993; the 43rd Annual Scientific Session of the American College of Cardiology, Atlanta, Ga, March 1994; and the 5th Scientific Sessions of the American Society of Echocardiography, San Francisco, Calif, June 1994.
From the Columbia University College of Physicians and Surgeons, Division of Cardiology, New York, NY (A.S.G., Z.S., M.J.S., D.W.L., O.O.A., R.A.R., D.K.B., D.L.K.); the University of Kentucky Medical Center, Division of Cardiology, Lexington (P.M.S.); and Danbury Hospital, Division of Cardiology, Danbury, Conn (A.M.K.).
Correspondence to Aasha S. Gopal, MD, Division of Cardiology, Columbia University, Atchley Pavilion 552, 161 Ft Washington Ave, New York, NY 10032.
Background Reliable, serial, noninvasive quantitative estimation of left ventricular ejection fraction is essential for selecting and timing therapeutic interventions in patients with heart disease. Equilibrium radionuclide angiography is widely used for this purpose but has well-recognized limitations. Advantages of echocardiography over equilibrium radionuclide angiography include assessment of wall motion, valvular pathology, and cardiac hemodynamics, in addition to portability, lack of radiation exposure, and substantially lower cost. However, conventional echocardiographic techniques are limited by geometric assumptions, image positioning errors, and use of subjective visual methods. To overcome these limitations, a three-dimensional echocardiographic method was developed. This study compares ejection fraction by three-dimensional echocardiography, quantitative two-dimensional echocardiography, and subjective two-dimensional echocardiographic visual estimation with that by equilibrium radionuclide angiography.
Methods and Results Fifty-one unselected patients with suspected heart disease underwent left ventricular ejection fraction determination by equilibrium radionuclide angiography and three-dimensional echocardiography using an interactive line-of-intersection display and a new algorithm, ventricular surface reconstruction, for volume computation. In 44 patients, ejection fractions were also estimated visually by experienced observers from two-dimensional echocardiography and by quantitative two-dimensional echocardiography using an apical biplane summation-of-disks algorithm. An excellent correlation was obtained between three-dimensional echocardiography and equilibrium radionuclide angiography (r=.94 to .97, SEE=3.64% to 5.35%; limits of agreement, 10.3% to 13.3%) without significant underestimation or overestimation. SEE values and limits of agreement were twofold to threefold lower than corresponding values for all two-dimensional echocardiographic techniques. In addition, interobserver variability was significantly lower for the three-dimensional echocardiographic method (10.2%) than for the apical biplane summation-of-disks method (26.1%) and subjective visual estimation (33.3%).
Conclusions Determination of ejection fraction by three-dimensional echocardiography yields results comparable to those obtained by equilibrium radionuclide angiography and is substantially superior to all two-dimensional echocardiographic methods. Therefore, three-dimensional echocardiography may be used for accurate serial quantification of left ventricular function as an alternative to equilibrium radionuclide angiography.
Key Words: echocardiography • heart function tests • imaging • computers
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