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Direct measurement of left ventricular outflow tract area using three-dimensional echocardiography in biplane mode improves accuracy of stroke volume assessment
KTH, School of Technology and Health (STH), Medical Engineering.
KTH, School of Technology and Health (STH), Medical Engineering.
KTH, School of Technology and Health (STH), Medical Engineering.
2010 (English)In: Echocardiography, ISSN 0742-2822, E-ISSN 1540-8175, Vol. 27, no 9, 1078-1085 p.Article 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.

Place, publisher, year, edition, pages
2010. Vol. 27, no 9, 1078-1085 p.
Keyword [en]
stroke volume, left ventricular outflow tract, three-dimensional echocardiography, biplane mode
National Category
Cardiac and Cardiovascular Systems
URN: urn:nbn:se:kth:diva-13799DOI: 10.1111/j.1540-8175.2010.01197.xISI: 000283690100007ScopusID: 2-s2.0-78349268299OAI: diva2:327366
QC20100629 Uppdaterad från acepted till published (20110207).Available from: 2010-06-29 Created: 2010-06-29 Last updated: 2011-02-07Bibliographically 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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