Comparison Between 3D Echocardiography and Cardiac Magnetic Resonance Imaging (CMRI) in the Measurement of Left Ventricular Volumes and Ejection Fraction

Author(s): Narjes Benameur* , Younes Arous , Nejmeddine Ben Abdallah , Tarek Kraiem .

Journal Name: Current Medical Imaging

Volume 15 , Issue 7 , 2019

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Abstract:

Background: Echocardiography and Cardiac Magnetic Resonance Imaging (CMRI) are two noninvasive techniques for the evaluation of cardiac function for patients with coronary artery diseases. Although echocardiography is the commonly used technique in clinical practice for the assessment of cardiac function, the measurement of LV volumes and left ventricular ejection fraction (LVEF) by the use of this technique is still influenced by several factors inherent to the protocol acquisition, which may affect the accuracy of echocardiography in the measurement of global LV parameters.

Objective: The aim of this study is to compare the end systolic volume (ESV), the end diastolic volume (EDV), and the LVEF values obtained with three dimensional echocardiography (3D echo) with those obtained by CMRI (3 Tesla) in order to estimate the accuracy of 3D echo in the assessment of cardiac function.

Methods: 20 subjects, (9 controls, 6 with myocardial infarction, and 5 with myocarditis) with age varying from 18 to 58, underwent 3D echo and CMRI. LV volumes and LVEF were computed from CMRI using a stack of cine MRI images in a short axis view. The same parameters were calculated using the 3D echo. A linear regression analysis and Bland Altman diagrams were performed to evaluate the correlation and the degree of agreement between the measurements obtained by the two methods.

Results: The obtained results show a strong correlation between the 3D echo and CMR in the measurement of functional parameters (r = 0.96 for LVEF values, r = 0.99 for ESV and r= 0.98 for EDV, p < 0.01 for all) with a little lower values of LV volumes and higher values of LVEF by 3D echo compared to CMRI. According to statistical analysis, there is a slight discrepancy between the measurements obtained by the two methods.

Conclusion: 3D echo represents an accurate noninvasive tool for the assessment of cardiac function. However, other studies should be conducted on a larger population including some complicated diagnostic cases.

Keywords: Cardiac MRI, 3D echocardiography, left ventricular ejection fraction, left ventricular volumes, correlation, cardiac function.

[1]
Huang H, Nijjar PS, Misialek JR, et al. Accuracy of left ventricular ejection fraction by contemporary multiple gated acquisition scanning in patients with cancer: comparison with cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19(1): 34.
[http://dx.doi.org/10.1186/s12968-017-0348-4] [PMID: 28335788]
[2]
Thomas AF, Sunil VM, Nandan SA, et al. Measuring left ventricular ejection fraction-techniques and potential pitfalls. Eur Cardiol 2012; 8: 108-14.
[http://dx.doi.org/10.15420/ecr.2012.8.2.108]
[3]
Singh RM, Singh BM, Mehta JL. Role of cardiac CTA in estimating left ventricular volumes and ejection fraction. World J Radiol 2014; 6(9): 669-76.
[http://dx.doi.org/10.4329/wjr.v6.i9.669] [PMID: 25276310]
[4]
Wood PW, Choy JB, Nanda NC, Becher H. Left ventricular ejection fraction and volumes: it depends on the imaging method. Echocardiography 2014; 31(1): 87-100.
[http://dx.doi.org/10.1111/echo.12331] [PMID: 24786629]
[5]
Rizvi A, Deaño RC, Bachman DP, Xiong G, Min JK, Truong QA. Analysis of ventricular function by CT. J Cardiovasc Comput Tomogr 2015; 9(1): 1-12.
[http://dx.doi.org/10.1016/j.jcct.2014.11.007] [PMID: 25576407]
[6]
Hansson NH, Tolbod L, Harms HJ, et al. Evaluation of ECG-gated [(11)C]acetate PET for measuring left ventricular volumes, mass, and myocardial external efficiency. J Nucl Cardiol 2016; 23(4): 670-9.
[http://dx.doi.org/10.1007/s12350-015-0331-0] [PMID: 27094041]
[7]
Omar AM, Bansal M, Sengupta PP. Advances in echocardiographic imaging in heart failure with reduced and preserved ejection fraction. Circ Res 2016; 119(2): 357-74.
[http://dx.doi.org/10.1161/CIRCRESAHA.116.309128] [PMID: 27390337]
[8]
Knackstedt C, Bekkers SC, Schummers G, et al. Fully automated versus standard tracking of left ventricular ejection fraction and longitudinal strain. J Am Coll Cardiol 2015; 66(13): 1456-66.
[http://dx.doi.org/10.1016/j.jacc.2015.07.052] [PMID: 26403342]
[9]
Picard MH, Popp RL, Weyman AE. Assessment of left ventricular function by echocardiography: a technique in evolution. J Am Soc Echocardiogr 2008; 21(1): 14-21.
[http://dx.doi.org/10.1016/j.echo.2007.11.007] [PMID: 18165124]
[10]
Cowie B, Kluger R, Kalpokas M. Left ventricular volume and ejection fraction assessment with transoesophageal echocardiography: 2D vs 3D imaging. Br J Anaesth 2013; 110(2): 201-6.
[http://dx.doi.org/10.1093/bja/aes350] [PMID: 23035054]
[11]
Lu JC, Ensing GJ, Yu S, Thorsson T, Donohue JE, Dorfman AL. 5/6 Area length method for left-ventricular ejection-fraction measurement in adults with repaired tetralogy of Fallot: comparison with cardiovascular magnetic resonance. Pediatr Cardiol 2013; 34(2): 231-9.
[http://dx.doi.org/10.1007/s00246-012-0420-7] [PMID: 22797483]
[12]
Ballo H, Tarkia M, Haavisto M, et al. Accuracy of echocardiographic area-length method in chronic myocardial infarction: comparison with cardiac CT in pigs. Cardiovasc Ultrasound 2017; 15(1): 1.
[http://dx.doi.org/10.1186/s12947-016-0093-0] [PMID: 28069008]
[13]
Nowosielski M, Schocke M, Mayr A, et al. Comparison of wall thickening and ejection fraction by cardiovascular magnetic resonance and echocardiography in acute myocardial infarction. J Cardiovasc Magn Reson 2009; 11: 22.
[http://dx.doi.org/10.1186/1532-429X-11-22] [PMID: 19589148]
[14]
Japp AG, Moir S, Mottram PM. Echocardiographic quantification of left ventricular systolic function. Heart Lung Circ 2015; 24(6): 532-5.
[http://dx.doi.org/10.1016/j.hlc.2015.01.017] [PMID: 25757873]
[15]
Baur LHB. Evaluation of left ventricular function: does the imaging technique matter? Int J Cardiovasc Imaging 2008; 24(8): 803-5.
[http://dx.doi.org/10.1007/s10554-008-9346-9] [PMID: 18651240]
[16]
Foley TA, Mankad SV, Anavekar NS, et al. Measuring left ventricular ejection fraction-techniques and potential pitfalls. Eur Cardiol Rev 2012; 8(2): 108-14.
[http://dx.doi.org/10.15420/ecr.2012.8.2.108]
[17]
Cikes M, Solomon SD. Beyond ejection fraction: an integrative approach for assessment of cardiac structure and function in heart failure. Eur Heart J 2016; 37(21): 1642-50.
[http://dx.doi.org/10.1093/eurheartj/ehv510] [PMID: 26417058]
[18]
Aljizeeri A, Sulaiman A, Alhulaimi N, Alsaileek A, Al-Mallah MH. Cardiac magnetic resonance imaging in heart failure: where the alphabet begins. Heart Fail Rev 2017; 22(4): 385-99.
[http://dx.doi.org/10.1007/s10741-017-9609-4] [PMID: 28432605]
[19]
Schulz-Menger J, Bluemke DA, Bremerich J, et al. Standardized image interpretation and post processing in cardiovascular magnetic resonance: Society for Cardiovascular Magnetic Resonance (SCMR) board of trustees task force on standardized post processing. J Cardiovasc Magn Reson 2013; 15: 35.
[http://dx.doi.org/10.1186/1532-429X-15-35] [PMID: 23634753]
[20]
Joshi SB, Connelly KA, Jimenez-Juan L, et al. Potential clinical impact of cardiovascular magnetic resonance assessment of ejection fraction on eligibility for cardioverter defibrillator implantation. J Cardiovasc Magn Reson 2012; 14: 69.
[http://dx.doi.org/10.1186/1532-429X-14-69] [PMID: 23043729]
[21]
Fratz S, Chung T, Greil GF, et al. Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease. J Cardiovasc Magn Reson 2013; 15: 51.
[http://dx.doi.org/10.1186/1532-429X-15-51] [PMID: 23763839]
[22]
Pennell DJ, Sechtem UP, Higgins CB, et al. Clinical indications for cardiovascular magnetic resonance (CMR): consensus Panel report. Eur Heart J 2004; 25(21): 1940-65.
[http://dx.doi.org/10.1016/j.ehj.2004.06.040] [PMID: 15522474]
[23]
Muzzarelli S, Ordovas K, Higgins CB. Cardiovascular MRI for the assessment of heart failure: focus on clinical management and prognosis. J Magn Reson Imaging 2011; 33(2): 275-86.
[http://dx.doi.org/10.1002/jmri.22433] [PMID: 21274968]
[24]
Liu YH, Wackers FJTh. Cardiovascular Imaging. CRC Press, Taylor & Francis Group, 2010.
[25]
Karamitsos TD, Hudsmith LE, Selvanayagam JB, Neubauer S, Francis JM. Operator induced variability in left ventricular measurements with cardiovascular magnetic resonance is improved after training. J Cardiovasc Magn Reson 2007; 9(5): 777-83.
[http://dx.doi.org/10.1080/10976640701545073] [PMID: 17891615]
[26]
Thavendiranathan P, Liu S, Verhaert D, et al. Feasibility, accuracy, and reproducibility of real-time full-volume 3D transthoracic echocardiography to measure LV volumes and systolic function: a fully automated endocardial contouring algorithm in sinus rhythm and atrial fibrillation. JACC Cardiovasc Imaging 2012; 5(3): 239-51.
[http://dx.doi.org/10.1016/j.jcmg.2011.12.012] [PMID: 22421168]
[27]
Chang SA, Lee SC, Kim EY, et al. Feasibility of single-beat full-volume capture real-time three-dimensional echocardiography and auto-contouring algorithm for quantification of left ventricular volume: validation with cardiac magnetic resonance imaging. J Am Soc Echocardiogr 2011; 24(8): 853-9.
[http://dx.doi.org/10.1016/j.echo.2011.04.015] [PMID: 21645992]
[28]
Spitzer E, Ren B, Zijlstra F, Mieghem NMV, Geleijnse ML. The Role of Automated 3D Echocardiography for Left Ventricular Ejection Fraction Assessment. Card Fail Rev 2017; 3(2): 97-101.
[http://dx.doi.org/10.15420/cfr.2017:14.1] [PMID: 29387460]
[29]
Dorosz JL, Lezotte DC, Weitzenkamp DA, Allen LA, Salcedo EE. Performance of 3-dimensional echocardiography in measuring left ventricular volumes and ejection fraction: a systematic review and meta-analysis. J Am Coll Cardiol 2012; 59(20): 1799-808.
[http://dx.doi.org/10.1016/j.jacc.2012.01.037] [PMID: 22575319]
[30]
Hansegård J, Urheim S, Lunde K, Malm S, Rabben SI. Semi-automated quantification of left ventricular volumes and ejection fraction by real-time three-dimensional echocardiography. Cardiovasc Ultrasound 2009; 7: 18.
[http://dx.doi.org/10.1186/1476-7120-7-18] [PMID: 19379479]
[31]
Levy F, Dan Schouver E, Iacuzio L, et al. Performance of new automated transthoracic three-dimensional echocardiographic software for left ventricular volumes and function assessment in routine clinical practice: Comparison with 3 Tesla cardiac magnetic resonance. Arch Cardiovasc Dis 2017; 110(11): 580-9.
[http://dx.doi.org/10.1016/j.acvd.2016.12.015] [PMID: 28566200]
[32]
Tsang W, Salgo IS, Medvedofsky D, et al. Transthoracic 3D Echocardiographic left heart chamber quantification using an automated adaptive analytics algorithm. JACC Cardiovasc Imaging 2016; 9(7): 769-82.
[http://dx.doi.org/10.1016/j.jcmg.2015.12.020] [PMID: 27318718]
[33]
Friedberg MK, Su X, Tworetzky W, Soriano BD, Powell AJ, Marx GR. Validation of 3D echocardiographic assessment of left ventricular volumes, mass, and ejection fraction in neonates and infants with congenital heart disease: a comparison study with cardiac MRI. Circ Cardiovasc Imaging 2010; 3(6): 735-42.
[http://dx.doi.org/10.1161/CIRCIMAGING.109.928663] [PMID: 20855861]
[34]
Aune E, Baekkevar M, Rødevand O, Otterstad JE. Reference values for left ventricular volumes with real-time 3-dimensional echocardiography. Scand Cardiovasc J 2010; 44(1): 24-30.
[http://dx.doi.org/10.3109/14017430903114446] [PMID: 19626561]
[35]
Hoffmann R, Barletta G, von Bardeleben S, et al. Analysis of left ventricular volumes and function: a multicenter comparison of cardiac magnetic resonance imaging, cine ventriculography, and unenhanced and contrast-enhanced two-dimensional and three-dimensional echocardiography. J Am Soc Echocardiogr 2014; 27(3): 292-301.
[http://dx.doi.org/10.1016/j.echo.2013.12.005] [PMID: 24440110]
[36]
Chahal NS, Lim TK, Jain P, Chambers JC, Kooner JS, Senior R. Population-based reference values for 3D echocardiographic LV volumes and ejection fraction. JACC Cardiovasc Imaging 2012; 5(12): 1191-7.
[http://dx.doi.org/10.1016/j.jcmg.2012.07.014] [PMID: 23236967]
[37]
Fukuda S, Watanabe H, Daimon M, et al. Normal values of real-time 3-dimensional echocardiographic parameters in a healthy Japanese population: the JAMP-3D Study. Circ J 2012; 76(5): 1177-81.
[http://dx.doi.org/10.1253/circj.CJ-11-1256] [PMID: 22361920]
[38]
van Dijk J, Dijkmans PA, Götte MJ, Spreeuwenberg MD, Visser CA, Kamp O. Evaluation of global left ventricular function and mechanical dyssynchrony in patients with an asymptomatic left bundle branch block: a real-time 3D echocardiography study. Eur J Echocardiogr 2008; 9(1): 40-6.
[PMID: 17446139]
[39]
Marwick TH. The role of echocardiography in heart failure. J Nucl Med 2015; 56: 31S-8S.
[http://dx.doi.org/10.2967/jnumed.114.150433] [PMID: 26033901]
[40]
Chong A, MacLaren G, Chen R, Connelly KA. Perioperative applications of deformation (myocardial strain) imaging with speckle-tracking echocardiography. J Cardiothorac Vasc Anesth 2014; 28(1): 128-40.
[http://dx.doi.org/10.1053/j.jvca.2013.04.020] [PMID: 24231194]
[41]
Vignola PA, Bloch A, Kaplan AD, Walker HJ, Chiotellis PN, Myers GS. Interobserver variability in echocardiography. J Clin Ultrasound 1977; 5(4): 238-42.
[http://dx.doi.org/10.1002/jcu.1870050405] [PMID: 407252]
[42]
Moody WE, Edwards NC, Chue CD, et al. Variability in cardiac MR measurement of left ventricular ejection fraction, volumes and mass in healthy adults: defining a significant change at 1 year. Br J Radiol 2015; 88(1049)20140831
[http://dx.doi.org/10.1259/bjr.20140831] [PMID: 25710361]
[43]
Singh RM, Singh BM, Mehta JL. Role of cardiac CTA in estimating left ventricular volumes and ejection fraction. World J Radiol 2014; 6(9): 669-76.
[http://dx.doi.org/10.4329/wjr.v6.i9.669] [PMID: 25276310]
[44]
Sun L, Feng H, Ni L, Wang H, Gao D. Realization of fully automated quantification of left ventricular volumes and systolic function using transthoracic 3D echocardiography. Cardiovasc Ultrasound 2018; 16(1): 2.
[http://dx.doi.org/10.1186/s12947-017-0121-8] [PMID: 29357888]
[45]
Vegas A. Three-dimensional transesophageal echocardiography: Principles and clinical applications. Ann Card Anaesth 2016; 19(1): S35-43.
[http://dx.doi.org/10.4103/0971-9784.192622] [PMID: 27762247]


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VOLUME: 15
ISSUE: 7
Year: 2019
Page: [654 - 660]
Pages: 7
DOI: 10.2174/1573405614666180815115756
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