Contrast Enhancement and Image Quality Influence Two- and Three-dimensional Echocardiographic Determination of Left Ventricular Volumes: Comparison With Magnetic Resonance Imaging

Jonas Jenner, Peder Sörensson, John Pernow, Kenneth Caidahl, Maria J Eriksson, Jonas Jenner, Peder Sörensson, John Pernow, Kenneth Caidahl, Maria J Eriksson

Abstract

Purpose: To evaluate the effect of image quality and contrast enhancement (CE) on left ventricular (LV) volume determination by two- (2D) and three-dimensional (3D) echocardiography (2DE/3DE).

Methods: We studied 32 post-myocardial infarction (MI) patients without (2DE/3DE) and with CE (CE2DE/CE3DE), in comparison with cardiac magnetic resonance imaging (CMR).

Results: Two-dimensional echocardiography showed the largest negative bias versus CMR for diastolic and systolic volumes (-59, -28 mL, respectively) with lower biases for CE2DE (-37, -22 mL), 3DE (-31, -17 mL), and CE3DE (-17, -11 mL). Bias for ejection fraction (EF) ranged from -2.1% for 2DE to +1.4% for CE3DE. Agreement (intraclass correlation coefficient, ICC) for EF between CMR and 3DE (0.86 without and 0.85 with contrast) was better than for 2DE (0.73 without and 0.69 with contrast). The inter-/intra-observer coefficients of variation for EF varied from 16%/10% (2DE) to 6.9%/6.6% (CE2DE), and 8.3%/4.8% (3DE) to 6.7%/6.8% (CE3DE), respectively. The agreement (ICC) with CMR for EF measured by 2DE/3DE changed from 0.64/0.84 with poor image quality to 0.81/0.87 with moderate to good image quality.

Conclusions: Three-dimensional echocardiography was more accurate than 2DE for estimating LV volumes, with less inter-/intra-observer variability in EF values. Contrast enhancement improved accuracy for both 2DE and 3DE and improved the inter-observer variability of EF estimates for 2DE and 3DE. Image quality had more impact on the agreement of EF values with CMR for 2DE than for 3DE. Our results emphasize the importance of using the same technique for longitudinal studies of LV EF and specially LV volumes.

Keywords: 2D echocardiography; 3D echocardiography; cardiac magnetic resonance imaging; contrast echocardiography; left ventricular ejection fraction; left ventricular volume.

Conflict of interest statement

Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Bland-Altman analyses of (top) 2DE- and (bottom) CE2DE-derived left ventricular volumes and ejection fraction against CMR values. Abbrevations: EDV, end-diastolic volume; ESV, end-systolic volume; EF; ejection fraction.
Figure 2.
Figure 2.
Bland-Altman analyses of (top) 3DE- and (bottom) CE3DE-derived left ventricular volumes and ejection fraction against CMR values. Abbreviations: EDV, end-diastolic volume; EF, ejection fraction; ESV, end-systolic volume.
Figure 3.
Figure 3.
Average of image quality score in each myocardial segment assessed on a scale from 0 (no visible endocardium) to 4 (endocardium visible, including clearly defined trabeculations): (Top) 2D echocardiography, (bottom) 3D echocardiography, (left column) without contrast), and (right column) with contrast. Asterisk (*) denotes significant differences between contrast-enhanced and non-enhanced images assessed by Wilcoxon signed-rank test using Bonferroni correction for multiple comparisons.
Figure 4.
Figure 4.
Typical example showing four chamber views with non-contrast-enhanced versus contrast-enhanced 2D images (top row). Corresponding images extracted from 3D full-volume data set (bottom row). Abbreviations: 2DE, two-dimensional echocardiography; 3DE three-dimensional echocardiography; CE2DE, contrast-enhanced two-dimensional echocardiography; CE3DE, contrast-enhanced three-dimensional echocardiography; LV, left ventricle. Arrows denote shadowing in the basal lateral segments in contrast-enhanced images. All images were acquired from the same subject.
Figure 5.
Figure 5.
Intra-observer variability for EF measured by 2DE with and without contrast (top), and by 3DE with and without contrast (bottom); n = 15. Abbreviation: EF, ejection fraction.
Figure 6.
Figure 6.
Inter-observer variability for EF by 2DE with and without contrast (top), and by 3DE with and without contrast (bottom); n = 15. Abbreviation: EF, ejection fraction.

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