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J Am Coll Cardiol, 2000; 36:900-907
© 2000 by the American College of Cardiology Foundation
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CLINICAL STUDY

Validation of real-time three-dimensional echocardiography for quantifying left ventricular volumes in the presence of a left ventricular aneurysm: in vitro and in vivo studies

Jian Xin Qin, MDa, Michael Jones, MDb, Takahiro Shiota, MD, PhD, FACCa, Neil L. Greenberg, PhDa, Hiroyuki Tsujino, MSa, Michael S. Firstenberg, MDa, Pankaj C. Gupta, BAa, Arthur D. Zettsb, Yong Xu, MDa, Jing Ping Sun, MDa, Lisa A. Cardon, RDCSa, Jill A. Odabashiana, Scott D. Flamm, MDa, Richard D. White, MDa, Julio A. Panza, MD, FACCc and James D. Thomas, MD, FACCa

a Cardiovascular Imaging Center, Department of Cardiology, the Cleveland Clinic Foundation, Cleveland, OhioUSA
b Laboratory of Animal Surgery and Medicine, National Institutes of Health, Bethesda, MarylandUSA
c Cardiology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA

Manuscript received September 30, 1999; revised manuscript received March 7, 2000, accepted April 14, 2000.

Reprint requests and correspondence: Dr. Takahiro Shiota, Department of Cardiology/Desk F 15, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195
shiotat{at}ccf.org

OBJECTIVES

To validate the accuracy of real-time three-dimensional echocardiography (RT3DE) for quantifying aneurysmal left ventricular (LV) volumes.

BACKGROUND

Conventional two-dimensional echocardiography (2DE) has limitations when applied for quantification of LV volumes in patients with LV aneurysms.

METHODS

Seven aneurysmal balloons, 15 sheep (5 with chronic LV aneurysms and 10 without LV aneurysms) during 60 different hemodynamic conditions and 29 patients (13 with chronic LV aneurysms and 16 with normal LV) underwent RT3DE and 2DE. Electromagnetic flow meters and magnetic resonance imaging (MRI) served as reference standards in the animals and in the patients, respectively. Rotated apical six-plane method with multiplanar Simpson’s rule and apical biplane Simpson’s rule were used to determine LV volumes by RT3DE and 2DE, respectively.

RESULTS

Both RT3DE and 2DE correlated well with actual volumes for aneurysmal balloons. However, a significantly smaller mean difference (MD) was found between RT3DE and actual volumes (–7 ml for RT3DE vs. 22 ml for 2DE, p = 0.0002). Excellent correlation and agreement between RT3DE and electromagnetic flow meters for LV stroke volumes for animals with aneurysms were observed, while 2DE showed lesser correlation and agreement (r = 0.97, MD = –1.0 ml vs. r = 0.76, MD = 4.4 ml). In patients with LV aneurysms, better correlation and agreement between RT3DE and MRI for LV volumes were obtained (r = 0.99, MD = –28 ml) than between 2DE and MRI (r = 0.91, MD = –49 ml).

CONCLUSIONS

For geometrically asymmetric LVs associated with ventricular aneurysms, RT3DE can accurately quantify LV volumes.

Abbreviations and Acronyms
  2DE = two-dimensional echocardiography
  EDV = end-diastolic volume
  EF = ejection fraction
  EM = electromagnetic flow meter
  ESV = end-systolic volume
  LV = left ventricle
  MD = mean difference
  MRI = magnetic resonance imaging
  RT3DE = real-time three-dimensional echocardiography
  SV = stroke volume




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