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Visually estimated ejection fraction by two dimensional and triplane echocardiography is closely correlated with quantitative ejection fraction by real-time three dimensional echocardiography
KTH, School of Technology and Health (STH), Medical Engineering.
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2009 (English)In: Cardiovascular Ultrasound, ISSN 1476-7120, Vol. 7Article in journal (Refereed) Published
Abstract [en]

Background: Visual assessment of left ventricular ejection fraction (LVEF) is often used in clinical routine despite general recommendations to use quantitative biplane Simpsons (BPS) measurements. Even thou quantitative methods are well validated and from many reasons preferable, the feasibility of visual assessment (eyeballing) is superior. There is to date only sparse data comparing visual EF assessment in comparison to quantitative methods available. The aim of this study was to compare visual EF assessment by two-dimensional echocardiography (2DE) and triplane echocardiography (TPE) using quantitative real-time three-dimensional echocardiography (RT3DE) as the reference method.

Methods: Thirty patients were enrolled in the study. Eyeballing EF was assessed using apical 4-and 2 chamber views and TP mode by two experienced readers blinded to all clinical data. The measurements were compared to quantitative RT3DE.

Results: There were an excellent correlation between eyeballing EF by 2D and TP vs 3DE (r = 0.91 and 0.95 respectively) without any significant bias (-0.5 +/- 3.7% and -0.2 +/- 2.9% respectively). Intraobserver variability was 3.8% for eyeballing 2DE, 3.2% for eyeballing TP and 2.3% for quantitative 3D-EF. Interobserver variability was 7.5% for eyeballing 2D and 8.4% for eyeballing TP.

Conclusion: Visual estimation of LVEF both using 2D and TP by an experienced reader correlates well with quantitative EF determined by RT3DE. There is an apparent trend towards a smaller variability using TP in comparison to 2D, this was however not statistically significant.

Place, publisher, year, edition, pages
2009. Vol. 7
Keyword [en]
URN: urn:nbn:se:kth:diva-12965DOI: 10.1186/1476-7120-7-41ISI: 000270295500003ScopusID: 2-s2.0-70349428505OAI: diva2:319900
QC20100629Available from: 2010-05-20 Created: 2010-05-20 Last updated: 2010-06-29Bibliographically approved
In thesis
1. Assessment of Left Ventricular Function and Hemodynamics Using Three-dimensional Echocardiography
Open this publication in new window or tab >>Assessment of Left Ventricular Function and Hemodynamics Using Three-dimensional Echocardiography
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Left ventricular (LV) volumes and ejection fraction (EF) are important predictors of cardiac morbidity and mortality. LV volumes provide valuable prognostic information which isparticularly useful in the selection of therapy or determination of the optimal time for surgery. Two-dimensional (2D) echocardiography is the most widely used non-invasive method forassessment of cardiac function, 2D echocardiography has however several limitations inmeasuring LV volumes and EF since the formulas for quantifications are based on geometricalassumptions. Three-dimensional (3D) echocardiography has been available for almost twodecades, although the use of this modality has not gained wide spread acceptance. 3D echocardiography can overcome the above mentioned limitation in LV volume and EF evaluation since it is not based on geometrical assumption. 3D echocardiography has been shownin several studies to be more accurate and reproducible with low inter- and intraobservervariability in comparison to 2D echocardiography regarding the measurements of LV volumesand EF.

The overall aim of the thesis was to evaluate the feasibility and accuracy of 3D echocardiography based-methods in the clinical context.

In Study I the feasibility of 3D echocardiography was investigated for determination of LV volumes and EF using parasternal, apical and subcostal approaches. The study demonstrated that the apical 3D echocardiography view offers superior visualization.

Study II tested the possibility of creating flow-volume loops to differentiate patients with valvular abnormalities from normal subjects. There were significant differences in the pattern from flow-volume loops clearly separating the groups.

In Study III the visual estimation, “eyeballing” of EF was evaluated with two- and tri-plane echocardiography in comparison to quantitative 3D echocardiography. The study confirmed that an experienced echocardiographer can, with a high level of agreement estimate EF both with two- and tri-plane echocardiography.

Study IV exposed the high accuracy of stroke volume and cardiac output determination using a3D biplane technique by planimetrically tracing the left ventricular outflow tract and indicating that an assumption of circular left ventricular outflow tract is not reliable.

In Study V, two 3D echocardiography modalities, single-beat and four-beat ECG-gated 3D echocardiography were evaluated in patients having sinus rhythm and atrial fibrillation. Thesingle-beat technique showed significantly lower inter-and intraobserver variability in LV volumes and EF measurements in patients having atrial fibrillation in comparison to four-beat ECG-gated acquisition due to absence of stitching artifact.

All studies demonstrated good results suggesting 3D echocardiography to be a feasible andaccurate method in daily clinical settings.

Place, publisher, year, edition, pages
Stockholm: KTH, 2010. xvi, 52 p.
Trita-STH : report, ISSN 1653-3836 ; 2010:2
Three-dimensional echocardiography, heart chambers, flow-volume loop, left ventricular ejection fraction, visualization, left ventricular stroke volume, left ventricular outflow tract, and single-heartbeat
National Category
Biomedical Laboratory Science/Technology
urn:nbn:se:kth:diva-12966 (URN)978-91-7415-621-8 (ISBN)
Public defence
2010-06-04, Huddinge sjukhus, lokal C1-87, Stockholm, 09:00 (English)
degree of Medical Doctor QC 20100629Available from: 2010-05-20 Created: 2010-05-20 Last updated: 2010-12-07Bibliographically approved

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