Comparison of three methods for quantitative assessment of left ventricular volume and ejection fraction by three-dimensional echocardiography and magnetic resonance imaging

Objective: Due to the growing number of patients with severely impaired cardiac function, a reliable assessment of left ventricular (LV) volumes and function is mandatory for perioperative management of heart surgery. Three-dimensional echocardiography (3D-Echo) has been proposed as alternative to magnetic resonance imaging (MRI), which is time consuming and poorly available for perioperative use. Aim of this study was to assess the accuracy of three different methods for quantifying LV volumes and ejection fraction by means of 3D-Echo compared to MRI. Methods: Thirty patients underwent 3D-Echo and MRI. Left ventricular end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) were assessed by means of three different methods: 4D-LV-Analysis, CardioView and Coons-Patches. 4D-LV-Analysis is based on automatic recognition of endocardial contours, CardioView and Coons-Patches are semiautomatic. 4D-LV-Analysis and CardioView are commercially available, while Coons-Patches technique has been developed at our institution. Results: LV volumes obtained by 4D-LV-Analysis and by CardioView showed no significant correlation to MRI. Only EF assessed by manual method CardioView was slightly correlated to MRI. EDV, ESV and EF assessed by Coons-Patches showed significant correlations to MRI. Bland-Altmann analysis showed that Coons-Patches technique overestimates LV Volumes. The bias for measuring EDV was 11.6 mL with a precision of±8.7 mL, for measuring ESV was 9.8±6.3 mL. EF measurements showed significant agreement between Coons-Patches and MRI (–2.7%±3.6%). Conclusions: Three-dimensional echocardiography along with the Coons-Patches technique provides a reliable noninvasive tool for perioperative and serial assessment of size, structure and function of left ventricle.