Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Assessment of Left Ventricular Function and Hemodynamics Using Three-dimensional Echocardiography
KTH, School of Technology and Health (STH), Medical Engineering.
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. , p. xvi, 52
Series
Trita-STH : report, ISSN 1653-3836 ; 2010:2
Keywords [en]
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
Identifiers
URN: urn:nbn:se:kth:diva-12966ISBN: 978-91-7415-621-8 (print)OAI: oai:DiVA.org:kth-12966DiVA, id: diva2:319924
Public defence
2010-06-04, Huddinge sjukhus, lokal C1-87, Stockholm, 09:00 (English)
Opponent
Supervisors
Note
degree of Medical Doctor QC 20100629Available from: 2010-05-20 Created: 2010-05-20 Last updated: 2010-12-07Bibliographically approved
List of papers
1. Comparison of different views with three-dimensional echocardiography: apical views offer superior visualization compared with parasternal and subcostal views
Open this publication in new window or tab >>Comparison of different views with three-dimensional echocardiography: apical views offer superior visualization compared with parasternal and subcostal views
Show others...
2008 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 28, no 6, p. 409-416Article in journal (Refereed) Published
Abstract [en]

Studies seeking to validate real-time three-dimensional echocardiography (3DE) with regard to cardiac function and dimensions have almost exclusively used apical views. However, it has never been examined whether apical views are preferable to parasternal or subcostal views. In the present study, we compared the feasibility of 3DE volumetric measurements of the four heart chambers in three different views. We included 40 patients planned for a routine two-dimensional transthoracic echocardiography examination (2DE). All patients were scanned with both 2DE and 3DE (Sonos 7500; Philips Medical Systems Andover, MA, USA). Parasternal, apical and subcostal views were used for 3DE. Volumes were calculated using manual tracing in 16 planes. 2DE was performed in parasternal longaxis, subcostal and apical four- and two-chamber views. Manual tracing was used for area calculations. To be judged fully traceable, 5/6 (85%) or more of the ventricular and atrial walls had to be adequately visualized in each plane. The left ventricle and left atrium were adequately visualized in the 3DE apical view in 34 (85%) and 40 (100%) patients, respectively. Visualization of the right atrium was adequate in 31 (78%) patients, whereas the right ventricle was adequately visualized in only 12 (30%) patients. The apical view of 3DE provided superior visualization of all four heart chambers compared with the parasternal and subcostal views, when applying a slight off-axis approach for both ventricles when needed. Thus, in the present study, there was no incremental value of assessment of chamber volumes in the parasternal and subcostal views.

Keywords
adult, 3DE, echocardiography, heart volumes, human, left atrium, left ventricle, right atrium, right ventricle, standard view, LEFT ATRIAL VOLUME, LEFT-VENTRICULAR VOLUMES, MAGNETIC-RESONANCE, EJECTION FRACTION, 2-DIMENSIONAL ECHOCARDIOGRAPHY, 3D ECHOCARDIOGRAPHY, DATA-ACQUISITION, VALIDATION, SIZE, ACCURACY
Identifiers
urn:nbn:se:kth:diva-12960 (URN)10.1111/j.1475-097X.2008.00823.x (DOI)000260049400009 ()
Note
QC20100629Available from: 2010-05-20 Created: 2010-05-20 Last updated: 2017-12-12Bibliographically approved
2. Flow-volume loops derived from three-dimensional echocardiography: a novel approach to the assessment of left ventricular hemodynamics
Open this publication in new window or tab >>Flow-volume loops derived from three-dimensional echocardiography: a novel approach to the assessment of left ventricular hemodynamics
Show others...
2008 (English)In: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 6Article in journal (Refereed) Published
Abstract [en]

Background: This study explores the feasibility of non-invasive evaluation of left ventricular (LV) flow-volume dynamics using 3-dimensional (3D) echocardiography, and the capacity of such an approach to identify altered LV hemodynamic states caused by valvular abnormalities.

Methods: Thirty-one patients with moderate-severe aortic (AS) and mitral (MS) stenoses (21 and 10 patients, respectively) and 10 healthy volunteers underwent 3D echocardiography with full volume acquisition using Philips Sonos 7500 equipment. The digital 3D data were post-processed using TomTec software. LV flow-volume loops were subsequently constructed for each subject by plotting instantaneous LV volume data sampled throughout the cardiac cycle vs. their first derivative representing LV flow. After correction for body surface area, an average flow-volume loop was calculated for each subject group.

Results: Flow-volume loops were obtainable in all subjects, except 3 patients with AS. The flow-volume diagrams displayed clear differences in the form and position of the loops between normal individuals and the respective patient groups. In patients with AS, an "obstructive" pattern was observed, with lower flow values during early systole and larger end-systolic volume. On the other hand, patients with MS displayed a "restrictive" flow-volume pattern, with reduced diastolic filling and smaller end-diastolic volume.

Conclusion: Non-invasive evaluation of LV flow-volume dynamics using 3D-echocardiographic data is technically possible and the approach has a capacity to identify certain specific types of alteration of LV flow-volume pattern caused by valvular abnormalities, thus reflecting underlying hemodynamic states specific for these abnormalities.

Keywords
CARDIAC MAGNETIC-RESONANCE, 2-DIMENSIONAL ECHOCARDIOGRAPHY, EJECTION FRACTION, MYOCARDIAL-INFARCTION, CINEVENTRICULOGRAPHY, QUANTIFICATION, TRANSDUCER, MORBIDITY, MORTALITY, ACCURACY
National Category
Medical Laboratory and Measurements Technologies
Identifiers
urn:nbn:se:kth:diva-12962 (URN)10.1186/1476-7120-6-13 (DOI)000255908600001 ()2-s2.0-42449155086 (Scopus ID)
Note
QC 20100629Available from: 2010-05-20 Created: 2010-05-20 Last updated: 2017-12-12Bibliographically approved
3. Visually estimated ejection fraction by two dimensional and triplane echocardiography is closely correlated with quantitative ejection fraction by real-time three dimensional echocardiography
Open this publication in new window or tab >>Visually estimated ejection fraction by two dimensional and triplane echocardiography is closely correlated with quantitative ejection fraction by real-time three dimensional echocardiography
Show others...
2009 (English)In: Cardiovascular Ultrasound, ISSN 1476-7120, E-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.

Keywords
ACUTE MYOCARDIAL-INFARCTION, HEART-FAILURE, ANGIOGRAPHY, QUANTIFICATION, PARAMETERS, SURVIVAL, VOLUMES, RISK
Identifiers
urn:nbn:se:kth:diva-12965 (URN)10.1186/1476-7120-7-41 (DOI)000270295500003 ()2-s2.0-70349428505 (Scopus ID)
Note
QC20100629Available from: 2010-05-20 Created: 2010-05-20 Last updated: 2017-12-12Bibliographically approved
4. Direct measurement of left ventricular outflow tract area using three-dimensional echocardiography in biplane mode improves accuracy of stroke volume assessment
Open this publication in new window or tab >>Direct measurement of left ventricular outflow tract area using three-dimensional echocardiography in biplane mode improves accuracy of stroke volume assessment
2010 (English)In: Echocardiography, ISSN 0742-2822, E-ISSN 1540-8175, Vol. 27, no 9, p. 1078-1085Article in journal (Refereed) Published
Abstract [en]

Aims: The aim of the study was to investigate whether left ventricular stroke volume (LVSV) assessment using direct measurement of left ventricular outflow tract area (LVOTA) is superior to conventional methods for SV calculation. Methods and results: Thirty patients were included in the study (39 +/- 12 years). LVSV was assessed by multiplying LVOT velocity time integral (VTI) by LVOTA provided by direct plani-metrical measurements from real time three-dimensional echocardiography (RT3DE) in biplane mode (SV2). These measurements were compared to conventional methods using either the LVOT diameter for LVOTA multiplied with VTI (SV1) or biplane Simpson (SV3). Direct SV measurements by RT3DE were used as gold standard (SVref). There was an excellent correlation and agreement between SV determined by SV2 and 3DE (r = 0.98, mean difference 0.5 +/- 3.3 mL). However, the concordance of the traditional methods (SV1 and SV3) with 3DE was weaker (r = 0.38, mean difference -2.0 +/- 17.6 mL, r = 0.84, mean difference -7.6 +/- 8.7 mL, respectively). Furthermore, cardiac output (CO) measurements performed by the different modalities were not concordant with wide limits of agreement, except by SV2 the mean difference of CO by SV1 was -0.12 +/- 1.05 L/min, 0.03 +/- 0.20 L/min by SV2, and -0.45 +/- 0.52 L/min by SV3. Conclusions: SV and CO calculations using direct measurement of LVOT area is a feasible, accurate and reproducible method and correlates extremely well with 3DE volume measurements. SV and CO calculation by LVOTA is therefore an appealing method for LVSV assessment in clinical routine.

Keywords
stroke volume, left ventricular outflow tract, three-dimensional echocardiography, biplane mode
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:kth:diva-13799 (URN)10.1111/j.1540-8175.2010.01197.x (DOI)000283690100007 ()2-s2.0-78349268299 (Scopus ID)
Note
QC20100629 Uppdaterad från acepted till published (20110207).Available from: 2010-06-29 Created: 2010-06-29 Last updated: 2017-12-12Bibliographically approved
5. Three-dimensional echocardiography using single-heartbeat modality decreases variability in measuring left ventricular volumes and function in comparison to four-beat technique in atrial fibrillation
Open this publication in new window or tab >>Three-dimensional echocardiography using single-heartbeat modality decreases variability in measuring left ventricular volumes and function in comparison to four-beat technique in atrial fibrillation
Show others...
2010 (English)In: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 8, no 1Article in journal (Refereed) Published
Abstract [en]

Background: Three dimensional echocardiography (3DE) approaches the accuracy of cardiac magnetic resonance in measuring left ventricular (LV) volumes and ejection fraction (EF). The multibeat modality in comparison to single-beat (SB) requires breath-hold technique and regular heart rhythm which could limit the use of this technique in patients with atrial fibrillation (AF) due to stitching artifact. The study aimed to investigate whether SB full volume 3DE acquisition reduces inter-and intraobserver variability in assessment of LV volumes and EF in comparison to four-beat (4B) ECG-gated full volume 3DE recording in patients with AF.

Methods: A total of 78 patients were included in this study. Fifty-five with sinus rhythm (group A) and 23 having AF (group B). 4B and SB 3DE was performed in all patients. LV volumes and EF was determined by these two modalities and inter-and intraobserver variability was analyzed.

Results: SB modality showed significantly lower inter-and intraobserver variability in group B in comparison to 4B when measuring LV volumes and EF, except for end-systolic volume (ESV) in intraobserver analysis. There were significant differences when calculating the LV volumes (p < 0.001) and EF (p < 0.05) with SB in comparison to 4B in group B.

Conclusion: Single-beat three-dimensional full volume acquisition seems to be superior to four-beat ECG-gated acquisition in measuring left ventricular volumes and ejection fraction in patients having atrial fibrillation. The variability is significantly lower both for ejection fraction and left ventricular volumes.

Keywords
CARDIAC MAGNETIC-RESONANCE, AUTOMATED BORDER-DETECTION, WALL-MOTION ABNORMALITIES, EJECTION FRACTION, MYOCARDIAL-INFARCTION, BEAT, ACCURACY, QUANTITATION, REPRODUCIBILITY, QUANTIFICATION
National Category
Medical Laboratory and Measurements Technologies
Identifiers
urn:nbn:se:kth:diva-13801 (URN)10.1186/1476-7120-8-45 (DOI)000283877100001 ()2-s2.0-77957267650 (Scopus ID)
Note
QC 20100629 Uppdaterad från submitted till published (20101207). Tidigare submitted till Journal of the American Society of Echocardiography.Available from: 2010-06-29 Created: 2010-06-29 Last updated: 2017-12-12Bibliographically approved

Open Access in DiVA

fulltext(3008 kB)988 downloads
File information
File name FULLTEXT01.pdfFile size 3008 kBChecksum SHA-512
08704a98afddd6bc13a03353896ba6e248f7e983669c9358618268bcdb4c6b5e1fd5d1909017e042036499c883b298cf90e71fb5fe18c7da59dcb2550194c518
Type fulltextMimetype application/pdf

Search in DiVA

By author/editor
Shahgaldi, Kambiz
By organisation
Medical Engineering
Biomedical Laboratory Science/Technology

Search outside of DiVA

GoogleGoogle Scholar
Total: 988 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 261 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf