Advertisement

A Meta-Analysis and Investigation for the Source of Bias of Left Ventricular Volumes and Function by Three-Dimensional Echocardiography in Comparison With Magnetic Resonance Imaging

      Determining accurate left ventricular (LV) function is clinically important. Three-dimensional echocardiography (3DE) achieves better estimation than 2-dimensional echocardiography. However, underestimation of LV volumes has often been reported without a systematic attempt to synthesize these data. This meta-analysis aimed to assess the bias of 3DE in evaluating LV volumes and ejection fraction (EF) and to investigate factors affecting that bias. Studies that compared LV volumes and/or EF between 3DE and magnetic resonance imaging were eligible. Meta-analysis of 95 studies including 3,055 subjects revealed significant underestimation of LV end-systolic volume (−4.7 ml, p <0.0001) and end-diastolic volume (−9.9 ml, p <0.0001), whereas measurement for EF revealed excellent accuracy (−0.13%, p = 0.41). Meta-regression analysis for factors of systematic bias in volumetry revealed that female gender and existence of cardiac disease were associated with more underestimation, whereas use of semiautomatic tracking and matrix-array transducers counteracted the underestimation. In conclusion, by meta-analysis synthesizing many small studies, we found underestimation of LV volumes and factors affecting the systematic bias by 3DE. These data provide a more detailed basis for analyzing and improving the accuracy of 3DE, an indispensable step toward further clinical application in LV assessment.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Suffoletto M.S.
        • Dohi K.
        • Cannesson M.
        • Saba S.
        • Gorcsan III, J.
        Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy.
        Circulation. 2006; 113: 960-968
        • Delgado V.
        • Ypenburg C.
        • van Bommel R.J.
        • Tops L.F.
        • Mollema S.A.
        • Marsan N.A.
        • Bleeker G.B.
        • Schalij M.J.
        • Bax J.J.
        Assessment of left ventricular dyssynchrony by speckle tracking strain imaging comparison between longitudinal, circumferential, and radial strain in cardiac resynchronization therapy.
        J Am Coll Cardiol. 2008; 51: 1944-1952
        • Ghai A.
        • Silversides C.
        • Harris L.
        • Webb G.D.
        • Siu S.C.
        • Therrien J.
        Left ventricular dysfunction is a risk factor for sudden cardiac death in adults late after repair of tetralogy of Fallot.
        J Am Coll Cardiol. 2002; 40: 1675-1680
        • Palmieri V.
        • Dahlöf B.
        • DeQuattro V.
        • Sharpe N.
        • Bella J.N.
        • de Simone G.
        • Paranicas M.
        • Fishman D.
        • Devereux R.B.
        Reliability of echocardiographic assessment of left ventricular structure and function: the PRESERVE study.
        J Am Coll Cardiol. 1999; 34: 1625-1632
        • Bellenger N.G.
        • Burgess M.I.
        • Ray S.G.
        • Lahiri A.
        • Coats A.J.
        • Cleland J.G.
        • Pennell D.J.
        Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance; are they interchangeable?.
        Eur Heart J. 2000; 21: 1387-1396
        • Jenkins C.
        • Bricknell K.
        • Chan J.
        • Hanekom L.
        • Marwick T.H.
        Comparison of two- and three-dimensional echocardiography with sequential magnetic resonance imaging for evaluating left ventricular volume and ejection fraction over time in patients with healed myocardial infarction.
        Am J Cardiol. 2007; 99: 300-306
        • Soriano B.D.
        • Hoch M.
        • Ithuralde A.
        • Geva T.
        • Powell A.J.
        • Kussman B.D.
        • Graham D.A.
        • Tworetzky W.
        • Marx G.R.
        Matrix-array 3-dimensional echocardiographic assessment of volumes, mass, and ejection fraction in young pediatric patients with a functional single ventricle: a comparison study with cardiac magnetic resonance.
        Circulation. 2008; 117: 1842-1848
        • Riehle T.J.
        • Mahle W.T.
        • Parks W.J.
        • Sallee III, D.
        • Fyfe D.A.
        Real-time three-dimensional echocardiographic acquisition and quantification of left ventricular indices in children and young adults with congenital heart disease: comparison with magnetic resonance imaging.
        J Am Soc Echocardiogr. 2008; 21: 78-83
        • Gutiérrez-Chico J.L.
        • Zamorano J.L.
        • Pérez de Isla L.
        • Orejas M.
        • Almería C.
        • Rodrigo J.L.
        • Ferreirós J.
        • Serra V.
        • Macaya C.
        Comparison of left ventricular volumes and ejection fractions measured by three-dimensional echocardiography versus by two-dimensional echocardiography and cardiac magnetic resonance in patients with various cardiomyopathies.
        Am J Cardiol. 2005; 95: 809-813
        • Buck T.
        • Hunold P.
        • Wentz K.U.
        • Tkalec W.
        • Nesser H.J.
        • Erbel R.
        Tomographic three-dimensional echocardiographic determination of chamber size and systolic function in patients with left ventricular aneurysm: comparison to magnetic resonance imaging, cineventriculography, and two-dimensional echocardiography.
        Circulation. 1997; 96: 4286-4297
        • Hubka M.
        • Bolson E.L.
        • McDonald J.A.
        • Martin R.W.
        • Munt B.
        • Sheehan F.H.
        Three-dimensional echocardiographic measurement of left and right ventricular mass and volume: in vitro validation.
        Int J Cardiovasc Imaging. 2002; 18: 111-118
        • Fei H.W.
        • Wang X.F.
        • Xie M.X.
        • Zhuang L.
        • Chen L.X.
        • Yang Y.
        • Huang R.Q.
        • Wang J.
        Validation of real-time three-dimensional echocardiography for quantifying left and right ventricular volumes: an experimental study.
        Chin Med J (Engl). 2004; 117: 695-699
        • Chukwu E.O.
        • Barasch E.
        • Mihalatos D.G.
        • Katz A.
        • Lachmann J.
        • Han J.
        • Reichek N.
        • Gopal A.S.
        Relative importance of errors in left ventricular quantitation by two-dimensional echocardiography: insights from three-dimensional echocardiography and cardiac magnetic resonance imaging.
        J Am Soc Echocardiogr. 2008; 21: 990-997
        • Mor-Avi V.
        • Jenkins C.
        • Kühl H.P.
        • Nesser H.J.
        • Marwick T.
        • Franke A.
        • Ebner C.
        • Freed B.H.
        • Steringer-Mascherbauer R.
        • Pollard H.
        • Weinert L.
        • Niel J.
        • Sugeng L.
        • Lang R.M.
        Real-time 3-dimensional echocardiographic quantification of left ventricular volumes: multicenter study for validation with magnetic resonance imaging and investigation of sources of error.
        JACC Cardiovasc Imaging. 2008; 1: 413-423
        • Alfakih K.
        • Plein S.
        • Thiele H.
        • Jones T.
        • Ridgway J.P.
        • Sivananthan M.U.
        Normal human left and right ventricular dimensions for MRI as assessed by turbo gradient echo and steady-state free precession imaging sequences.
        J Magn Reson Imaging. 2003; 17: 323-329