Single-Beat Versus Multibeat Real-Time 3D Echocardiography for Assessing Left Ventricular Volumes and Ejection Fraction

Abstract

Background-Real-time 3-dimensional echocardiography (RT3DE) is superior to 2D echocardiography in assessing left ventricular (LV) volumes and ejection fraction (EF), but its feasibility is limited by multibeat acquisition, which requires an optimal breath-hold and a regular heart rhythm. We sought to evaluate the accuracy and feasibility of single-and 2-beat RT3DE for LV volume and EF assessment. Methods and Results-Sixty-six consecutive patients referred for cardiac magnetic resonance (CMR) underwent RT3DEand CMR on the same day. Of the 50 patients (age, 59Ϯ18 years; 68% men; 42% coronary artery disease; LVEFϭ49Ϯ14%; limits, 14% to 76%) with an adequate RT3DE image quality, accuracy for LV volumes and EF measurements of single-and 2-beat modalities were compared with the conventional 4-beat acquisition and CMR.Correlations with CMR for LV end-diastolic volume (161Ϯ59 mL, rϭ0.93 to 0.94) and end-systolic volume (86Ϯ56 mL, rϭ0.93 to 0.96) were excellent regardless of the number of cardiac cycles used. However, because of the low temporal resolution (7Ϯ2 volumes per second), single-beat underestimated LVEF (bias, Ϫ5Ϯ8%) with greater bias than 2-beat (bias, 1Ϯ6%, PϽ0.001) and 4-beat (bias, 3Ϯ7%, PϽ0.001) modalities. Interestingly, 2-beat provided accuracy similar to 4-beat for end-diastolic volume (bias, Ϫ17Ϯ21 mL versus Ϫ15Ϯ23 mL), end-systolic volume (bias, Ϫ9Ϯ16 mL versus Ϫ12Ϯ17 mL), and LVEF (bias, 1Ϯ6% versus 3Ϯ7%) measurements, but fewer stitching artifacts were observed with 2-than 4-beat modalities (3% versus 30%). Conclusions-Compared with conventional multibeat acquisitions, 2-beat modality provides similar accuracy in LV volume and EF measurements and should be preferred due to fewer stitching artifacts. In contrast, the temporal resolution of single-beat modality appears insufficient to provide an accurate estimation of LVEF. (Circ Cardiovasc Imaging. 2010;3:450-455.)

Feasibility, Accuracy, and Reproducibility of Real-Time Full-Volume 3D Transthoracic Echocardiography to Measure LV Volumes and Systolic Function

“…We were able to use data from 89% of the patients with AF who were recruited from the TTE laboratory, consistent with previously reported feasibility rates in quantitative 2D TTE (14). Lastly, our exclusion rate is not different from previous 3D studies (5,15,16). Although image quality is important for clinical adoption, quantitative 3D TTE is not performed in current practice even when there is excellent image quality due to lack of intuitive workflow.…”

Age-, Body Size-, and Sex-Specific Reference Values for Right Ventricular Volumes and Ejection Fraction by Three-Dimensional Echocardiography

“…In addition, single-beat full-volume acquisitions have either low temporal and limited spatial resolution that may impair the accuracy of volume and EF measurements. 36 The absence of a comparison with a reference standard, such as CMR, could be regarded as a limitation of this study. However, several studies comparing 3DE and CMR to assess RV volumes and EF have documented the accuracy of 3DE and consistently reported smaller volumes by 3DE than by CMR in normal subject, as well as in a variety of cardiac diseases.…”

Feasibility of One-Beat Real-Time Full-Volume Three-Dimensional Echocardiography for Assessing Left Ventricular Volumes and Deformation Parameters

“…13 However, regardless of the attractiveness of one-beat acquisition to overcome these problems, low volume rates prevent the detection of minimal LV volumes, which means that the LVEF will be underestimated. 7 Consequently, Macron et al 2 proposed two-beat acquisition (mean volume rate, 15 6 5 vps), because they found that its LV quantification accuracy was not significantly different from that of four-beat acquisition (mean volume rate, 27 6 8 vps). Several studies 8,14,15 have investigated the accuracy of LV volumes and LVEF using the onebeat automatic contouring technique (Siemens Medical Solutions USA, Mountain View, CA) by comparing it with CMR or with fourbeat 3DE quantification software (QLAB; Philips Healthcare, Best, The Netherlands), 16 and all reported moderate to good correlations between 3DE one-beat-and CMR-derived LV parameters.…”

“…2,4 Advances in three-dimensional (3D) echocardiographic (3DE) imaging in the past few decades undoubtedly permit more comprehensive assessments of LV mechanics in 3D space. For instance, 3D full-volume data sets efficiently provide more information than do multiple 2D cut-plane acquisitions, because all of the LV myocardium is simultaneously displayed.…”

“…5,6 However, current 3DE full-volume data acquisition requires multibeat data acquisition to create full-volume data sets with high temporal and spatial resolution, which sometimes produces stitching artifacts, particularly in patients with irregular heart rhythms and those who cannot control their respiration. 2 To overcome this obstacle and broaden the clinical use of 3DE imaging, researchers have explored the feasibility of acquiring one-beat full-volume data sets with a relatively high volume rate. 7,8 This breakthrough is promising and might usher 3DE imaging into mainstream use.…”