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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
KTH, School of Technology and Health (STH), Medical Engineering.
KTH, School of Technology and Health (STH), Medical Engineering.
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2010 (English)In: Cardiovascular Ultrasound, 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.

Place, publisher, year, edition, pages
2010. Vol. 8, no 1
Keyword [en]
National Category
Medical Laboratory and Measurements Technologies
URN: urn:nbn:se:kth:diva-13801DOI: 10.1186/1476-7120-8-45ISI: 000283877100001ScopusID: 2-s2.0-77957267650OAI: diva2:327371
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: 2010-12-07Bibliographically 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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