Assessment of systolic left ventricular function: a multi-centre comparison of cineventriculography, cardiac magnetic resonance imaging, unenhanced and contrast-enhanced echocardiography

Abstract

Unenhanced echocardiography resulted in slight underestimation of EF and only moderate correlation compared with cineventriculography and MRI. Contrast echocardiography resulted in more accurate EF and significantly improved correlation with cineventriculography and MRI. Contrast echocardiography significantly improved inter-observer agreement on EF compared with unenhanced echocardiography. Inter-observer reliability on EF using contrast echocardiography reaches a level comparable to MRI and is better than those obtained by cineventriculography.

Contrast-enhanced versus non-enhanced three-dimensional echocardiography of left ventricular volumes

“…19 Several earlier studies investigated the influence of contrast enhancement on LV endocardial wall visibility and volume measurements using both 2DE and 3DE, as described schematically in table 2. [11][12][13][14][15][16][17][18][19][20][21][22]25 Among these, the results of two 2D studies using the ultrasound contrast agent Levovist are in line with the present study (a significant increase in LV volumes), effects that were ascribed to ultrasound contrast filling up intertrabecular space. 17,19 A similar study with EchoGen showed a small but significant decrease in LV end-diastolic volume, and no change in LV endsystolic volume and ejection fraction measurements.…”

“…Consistently, ultrasound contrast infusion led to improved endocardial visibility [11][12][13][14][15][16]18,21,25 and (when assessed) to improved volume measurement reproducibility. 17,19,21,22 In our patient group acoustic windows were good even without ultrasound contrast enhancement, but with the 3DE method we used, image reconstruction inherently causes a slight deterioration in image quality. We therefore sought to improve image quality by the use of contrast infusion, but we were not able to demonstrate significant improvement in LV volume measurement reproducibility.…”

“…[11][12][13][14][15][16][17] Besides improved endocardial border definition, several studies observed larger LV volumes following ultrasound contrast administration. [11][12][13][14][15][16][17][18][19][20][21][22] This may be explained by the fact that the LV contrast fills up the intertrabecular space, thereby delineating the outermost rather than the innermost endocardial contour. Although ultrasound contrast agents have the potential to improve LV volume measurement reproducibility, the question arises where the LV cavity boundaries should be drawn: i.e.…”

Automated frame‐by‐frame endocardial border detection from cardiac magnetic resonance images for quantitative assessment of left ventricular function: Validation and clinical feasibility

“…Today, this modality provides multiplane dynamic images of the beating heart with excellent spatial resolution and temporal resolution of 30 phases per cardiac cycle, which is comparable to what has been for many years the standard frame rate in 2D echocardiography. The combination of these features places CMR imaging as the tentative "gold standard" for LV size and function, as reflected by multiple publications in which it was used as such to validate other noninvasive techniques (3)(4)(5)(6)(7)(8)(9)(10)(11)(12).…”

“…trast resolution that has become the standard reference in the assessment of left ventricular (LV) size and function (1,2), against which other techniques are frequently validated (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). However, this technique relies on the detection of endocardial boundaries, which requires frame-by-frame manual tracing on multiple slices, and is thus of limited value in clinical practice.…”