Key result
Contrast-enhanced 3D echo most accurately estimates LV volumes versus CMR with minimal bias.
Why the study?
To evaluate the effect of image quality and contrast enhancement on left ventricular volume determination by two- and three-dimensional echocardiography compared with cardiac magnetic resonance imaging.
Does contrast enhancement and 3D echocardiography improve the accuracy of left ventricular volume and ejection fraction determination compared to CMR in post-MI patients?
Observational (n=32)
Does contrast enhancement and 3D echocardiography improve the accuracy of left ventricular volume and ejection fraction determination compared to CMR in post-MI patients?
Three-dimensional echocardiography with contrast enhancement provides the most accurate estimation of left ventricular volumes and ejection fraction compared to CMR, with less inter- and intra-observer variability.
Supports contrast-enhanced 3D echo for LV volumetry in post-MI; leaves open prospective validation versus CMR.
PURPOSE: To evaluate the effect of image quality and contrast enhancement (CE) on left ventricular (LV) volume determination by two- (2D) and three-dimensional (3D) echocardiography (2DE/3DE). METHODS: We studied 32 post-myocardial infarction (MI) patients without (2DE/3DE) and with CE (CE2DE/CE3DE), in comparison with cardiac magnetic resonance imaging (CMR). RESULTS: Two-dimensional echocardiography showed the largest negative bias versus CMR for diastolic and systolic volumes (-59, -28 mL, respectively) with lower biases for CE2DE (-37, -22 mL), 3DE (-31, -17 mL), and CE3DE (-17, -11 mL). Bias for ejection fraction (EF) ranged from -2.1% for 2DE to +1.4% for CE3DE. Agreement (intraclass correlation coefficient, ICC) for EF between CMR and 3DE (0.86 without and 0.85 with contrast) was better than for 2DE (0.73 without and 0.69 with contrast). The inter-/intra-observer coefficients of variation for EF varied from 16%/10% (2DE) to 6.9%/6.6% (CE2DE), and 8.3%/4.8% (3DE) to 6.7%/6.8% (CE3DE), respectively. The agreement (ICC) with CMR for EF measured by 2DE/3DE changed from 0.64/0.84 with poor image quality to 0.81/0.87 with moderate to good image quality. CONCLUSIONS: Three-dimensional echocardiography was more accurate than 2DE for estimating LV volumes, with less inter-/intra-observer variability in EF values. Contrast enhancement improved accuracy for both 2DE and 3DE and improved the inter-observer variability of EF estimates for 2DE and 3DE. Image quality had more impact on the agreement of EF values with CMR for 2DE than for 3DE. Our results emphasize the importance of using the same technique for longitudinal studies of LV EF and specially LV volumes.
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Jenner et al. (2019) conducted an observational in post-myocardial infarction (n=32). Two- and three-dimensional echocardiography with and without contrast enhancement vs. Cardiac magnetic resonance imaging (CMR) was evaluated on Bias versus CMR for diastolic and systolic volumes. Compared to CMR, 3D echocardiography with contrast enhancement was the most accurate method for estimating LV volumes, showing the lowest bias for diastolic (-17 mL) and systolic (-11 mL) volumes.
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