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The use of live three-dimensional Doppler echocardiography in the measurement of cardiac output

An in vivo animal study

James Pemberton, MD^*, Xiaokui Li, MD^*, Tara Karamlou, MD, Chloe A. Sandquist, MD, Karl Thiele, PhD, Irving Shen, MD, Ross M. Ungerleider, MD, Antoinette Kenny, MD and David J. Sahn, MD, MACC^*,*

^{* *}Clinical Care Center for Congenital Heart Disease
Department of Pediatric Cardiac Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
Philips Medical Systems, Andover, Massachusetts
Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom

View larger version (57K): [in a new window]   Figure 1 (A) Three-dimensional echocardiography (3-DE) color Doppler volume showing the Doppler signal filling the left ventricular outflow tract (LVOT). The septum can also be seen in the image. The three-dimensional volume calculation software uses the Doppler signal in the LVOT. (B) The two perpendicular cut planes of the three-dimensional Doppler volume at the level of the LVOT and aortic valve (AV). The color Doppler signal fills the LVOT. The sampling curve (the level at which the volume calculation will be performed) has been placed at the level of the AV. (C) A third plane at the level of the sampling curve (in this case the AV) as if the LVOT is being viewed from the left ventricular cavity. The color Doppler signal is seen within the outlined area of interest. (D) The flow velocity profile within the outlined area of interest over the course of the cardiac cycle and the flow rate and stroke volume calculation for that cycle in the green highlighted area.

View larger version (14K): [in a new window]   Figure 2 Linear regression analysis for the 143 data points in the 16 animals showing good correlation (y = 1.1x – 9.82, R2 = 0.93) between the three-dimensional Doppler cardiac output (CO)-derived computations and the flow meter measurements. Other abbreviations as in Figure 1.

View larger version (14K): [in a new window]   Figure 3 Linear regression analysis for the combined results from each animal showing excellent correlation (y = 1.11x – 17.5, R2 = 0.99) between the two methods of CO calculation. Abbreviations as in Figures 1 and 2.

View larger version (18K): [in a new window]   Figure 4 Level of agreement between the individual results of the two methods of CO calculation according to the Bland-Altman method. Abbreviations as in Figures 1 and 2.