CLINICAL STUDIES
Importance of imaging method over imaging modality in noninvasive determination of left ventricular volumes and ejection fraction
Assessment by two- and three-dimensional echocardiography and magnetic resonance imaging
Michael L. Chuang, MS*,
Mark G. Hibberd, MD, PhD*,
Carol J. Salton, BA*,
Raymond A. Beaudin, MS ,
Marilyn F. Riley, BS*,
Robert A. Parker, ScD ,
Pamela S. Douglas, MD, FACC* and
Warren J. Manning, MD, FACC* 
* Charles A. Dana Research Institute and the Harvard-Thorndike Laboratory of the Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
Hewlett Packard Company, Andover, Massachusetts, USA
Biometrics Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
Manuscript received January 8, 1999;
revised manuscript received September 10, 1999,
accepted October 21, 1999.
Reprint requests and correspondence: Dr. Warren J. Manning, Cardiovascular Division, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215
wmanning{at}caregroup.harvard.edu
OBJECTIVES
This study sought to determine the concordance between biplane and volumetric echocardiography and magnetic resonance imaging (MRI) strategies and their impact on the classification of patients according to left ventricular (LV) ejection fraction (EF) (LVEF).
BACKGROUND
Transthoracic echocardiography and MRI are noninvasive imaging modalities well suited for serial evaluation of LV volume and LVEF. Despite the accuracy and reproducibility of volumetric methods, quantitative biplane methods are commonly used, as they minimize both scanning and analysis times.
METHODS
Thirty-five adult subjects, including 25 patients with dilated cardiomyopathies, were evaluated by biplane and volumetric (cardiac short-axis stack) cine MRI and by biplane and volumetric (three-dimensional) transthoracic echocardiography. Left ventricular volume, LVEF and LV function categories (LVEF  55%, >35% to <55% and  35%) were then determined.
RESULTS
Biplane echocardiography underestimated LV volume with respect to the other three strategies (p < 0.01). There were no significant differences (p > 0.05) between any of the strategies for quantitative LVEF. Volumetric MRI and volumetric echocardiography differed by a single functional category for 2 patients (8%). Six to 11 patients (24% to 44%) differed when comparing biplane and volumetric methods. Ten patients (40%) changed their functional status when biplane MRI and biplane echocardiography were compared; this comparison also revealed the greatest mean absolute difference in estimates of EF for those subjects whose EF functional category had changed.
CONCLUSIONS
Volumetric MRI and volumetric echocardiographic measures of LV volume and LVEF agree well and give similar results when used to stratify patients with dilated cardiomyopathy according to systolic function. Agreement is poor between biplane and volumetric methods and worse between biplane methods, which assigned 40% of patients to different categories according to LVEF. The choice of imaging method (volumetric or biplane) has a greater impact on the results than does the choice of imaging modality (echocardiography or MRI) when measuring LV volume and systolic function.
|
Abbreviations and Acronyms
| | 2D | = two-dimensional | | 3D | = three-dimensional | | ED | = end-diastolic | | EDV | = end-diastolic volume | | EF | = ejection fraction | | ES | = end-systolic | | ESV | = end-systolic volume | | LV | = left ventricle or ventricular | | LVEF | = left ventricular ejection fraction | | MRI | = magnetic resonance imaging |
|
This article has been cited by other articles:
|
|
|
|
 
M. J. Antunes, M. Biernat, E. Sola, L. Oliveira, D. Prieto, F. Franco, and L. A. Providencia
Cardiac allograft systolic function. Is the aetiology (ischaemic or idiopathic) a determinant of ventricular function in the heart transplant patient?
Interactive CardioVascular and Thoracic Surgery,
August 1, 2008;
7(4):
586 - 590.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. H. Marwick and M. Schwaiger
The Future of Cardiovascular Imaging in the Diagnosis and Management of Heart Failure, Part 1: Tasks and Tools
Circ Cardiovasc Imaging,
July 1, 2008;
1(1):
58 - 69.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Jansen, M. Mischi, F. Bracke, J. m. van Dantzig, K. Peels, E. Lamfers, N. van Hemel, and H. Korsten
Novel ultrasound contrast agent dilution method for the assessment of ventricular ejection fraction
Eur J Echocardiogr,
July 1, 2008;
9(4):
489 - 493.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. L. Gutierrez-Chico, J. L. Zamorano, E. Prieto-Moriche, R. A. Hernandez-Antolin, M. Bravo-Amaro, L. Perez de Isla, M. Sanmartin-Fernandez, J. A. Baz-Alonso, and A. Iniguez-Romo
Real-time three-dimensional echocardiography in aortic stenosis: a novel, simple, and reliable method to improve accuracy in area calculation
Eur. Heart J.,
May 2, 2008;
29(10):
1296 - 1306.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Han, D. C. Peters, C. J. Salton, D. Bzymek, R. Nezafat, B. Goddu, K. V. Kissinger, P. J. Zimetbaum, W. J. Manning, and S. B. Yeon
Cardiovascular magnetic resonance characterization of mitral valve prolapse.
J. Am. Coll. Cardiol. Img.,
May 1, 2008;
1(3):
294 - 303.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. O. Ntim and W. G. Hundley
Cardiac Imaging in Patients With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure
J. Am. Coll. Cardiol.,
May 8, 2007;
49(18):
1900 - 1901.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. L.J.H. Kietselaer, C. P.M. Reutelingsperger, H. H. Boersma, G. A.K. Heidendal, I. H. Liem, H. J.G.M. Crijns, J. Narula, and L. Hofstra
Noninvasive Detection of Programmed Cell Loss with 99mTc-Labeled Annexin A5 in Heart Failure
J. Nucl. Med.,
April 1, 2007;
48(4):
562 - 567.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M S. J. Sutton and M G Keane
Reverse remodelling in heart failure with cardiac resynchronisation therapy
Heart,
February 1, 2007;
93(2):
167 - 171.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Cannesson, M. Tanabe, M. S. Suffoletto, D. M. McNamara, S. Madan, J. M. Lacomis, and J. Gorcsan III
A Novel Two-Dimensional Echocardiographic Image Analysis System Using Artificial Intelligence-Learned Pattern Recognition for Rapid Automated Ejection Fraction
J. Am. Coll. Cardiol.,
January 16, 2007;
49(2):
217 - 226.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Jahnke, I. Paetsch, R. Gebker, A. Bornstedt, E. Fleck, and E. Nagel
Accelerated 4D Dobutamine Stress MR Imaging with k-t BLAST: Feasibility and Diagnostic Performance
Radiology,
December 1, 2006;
241(3):
718 - 728.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. P. Nikitin, C. Constantin, P. H. Loh, J. Ghosh, E. I. Lukaschuk, A. Bennett, S. Hurren, F. Alamgir, A. L. Clark, and J. G.F. Cleland
New generation 3-dimensional echocardiography for left ventricular volumetric and functional measurements: Comparison with cardiac magnetic resonance
Eur J Echocardiogr,
October 1, 2006;
7(5):
365 - 372.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al.
ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death)
J. Am. Coll. Cardiol.,
September 5, 2006;
48(5):
e247 - e346.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al.
ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Europace,
September 1, 2006;
8(9):
746 - 837.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Sugeng, V. Mor-Avi, L. Weinert, J. Niel, C. Ebner, R. Steringer-Mascherbauer, F. Schmidt, C. Galuschky, G. Schummers, R. M. Lang, et al.
Quantitative Assessment of Left Ventricular Size and Function: Side-by-Side Comparison of Real-Time Three-Dimensional Echocardiography and Computed Tomography With Magnetic Resonance Reference
Circulation,
August 15, 2006;
114(7):
654 - 661.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. D. Jacobs, I. S. Salgo, S. Goonewardena, L. Weinert, P. Coon, D. Bardo, O. Gerard, P. Allain, J. L. Zamorano, L. P. de Isla, et al.
Rapid online quantification of left ventricular volume from real-time three-dimensional echocardiographic data
Eur. Heart J.,
February 2, 2006;
27(4):
460 - 468.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Burkhoff, I. Mirsky, and H. Suga
Assessment of systolic and diastolic ventricular properties via pressure-volume analysis: a guide for clinical, translational, and basic researchers
Am J Physiol Heart Circ Physiol,
August 1, 2005;
289(2):
H501 - H512.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Carlhall, L. Wigstrom, E. Heiberg, M. Karlsson, A. F. Bolger, and E. Nylander
Contribution of mitral annular excursion and shape dynamics to total left ventricular volume change
Am J Physiol Heart Circ Physiol,
October 1, 2004;
287(4):
H1836 - H1841.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. S. Maurer, M. Packer, D. Burkhoff, D. L. King, M. Grieff, M. R. Zile, C. F. Baicu, W. H. Gaasch, and M. M. Redfield
Diastolic Heart Failure
N. Engl. J. Med.,
September 9, 2004;
351(11):
1143 - 1145.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Jenkins, K. Bricknell, L. Hanekom, and T. H. Marwick
Reproducibility and accuracy of echocardiographic measurements of left ventricular parameters using real-time three-dimensional echocardiography
J. Am. Coll. Cardiol.,
August 18, 2004;
44(4):
878 - 886.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Carlsson, P. Cain, C. Holmqvist, F. Stahlberg, S. Lundback, and H. Arheden
Total heart volume variation throughout the cardiac cycle in humans
Am J Physiol Heart Circ Physiol,
July 1, 2004;
287(1):
H243 - H250.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. A. Whalley, G. D. Gamble, H. J. Walsh, S. P. Wright, S. Agewall, N. Sharpe, and R. N. Doughty
Effect of tissue harmonic imaging and contrast upon between observer and test-retest reproducibility of left ventricular ejection fraction measurement in patients with heart failure
Eur J Heart Fail,
January 1, 2004;
6(1):
85 - 93.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T H Marwick
Techniques for comprehensive two dimensional echocardiographic assessment of left ventricular systolic function
Heart,
November 1, 2003;
89(90003):
iii2 - 8.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. G. St John Sutton, T. Plappert, W. T. Abraham, A. L. Smith, D. B. DeLurgio, A. R. Leon, E. Loh, D. Z. Kocovic, W. G. Fisher, M. Ellestad, et al.
Effect of Cardiac Resynchronization Therapy on Left Ventricular Size and Function in Chronic Heart Failure
Circulation,
April 22, 2003;
107(15):
1985 - 1990.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J. Salton, M. L. Chuang, C. J. O'Donnell, M. J. Kupka, M. G. Larson, K. V. Kissinger, R. R. Edelman, D. Levy, and W. J. Manning
Gender differences and normal left ventricular anatomy in an adult population free of hypertension: A cardiovascular magnetic resonance study of the Framingham Heart Study Offspring cohort
J. Am. Coll. Cardiol.,
March 20, 2002;
39(6):
1055 - 1060.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W Y Kim, P Søgaard, P T Mortensen, H K. Jensen, A K. Pedersen, B O Kristensen, and H Egeblad
Three dimensional echocardiography documents haemodynamic improvement by biventricular pacing in patients with severe heart failure
Heart,
May 1, 2001;
85(5):
514 - 520.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
G. Germano, D. S. Berman, A. J. Sinusas, and F. J. Th. Wackers
Quantitative Gated SPECT
J. Nucl. Med.,
March 1, 2001;
42(3):
528 - 529.
[Full Text]
|
|
|
|
