Left ventricular volume measurement with echocardiography: a comparison of left ventricular opacification, three-dimensional echocardiography, or both with magnetic resonance imaging

Aims: Both contrast enhanced (CE) two-dimensional echocardiography(2DE) and three-dimensional echocardiography (3DE) have beenproposed as techniques to improve the accuracy of left ventricular(LV) volume measurements. We sought to examine the accuracyof non-contrast (NC) and CE-2DE and 3DE for calculation of LVvolumes and ejection fraction (EF), relative to cardiac magneticresonance imaging (MRI). Methods and results: We studied 50 patients (46 men, age 63 ± 10 year) withpast myocardial infarction who underwent echocardiographic assessmentof LV volume and function. All patients sequentially underwentNC-2DE followed by NC-3DE. CE-2DE and CE-3DE were acquired duringcontrast infusion. Resting echocardiographic image quality wasevaluated on the basis of NC-2DE. The mean LV end-diastolicvolume (LVEDV) of the group by MRI was 207 ± 79 mL andwas underestimated by 2DE (125 ± 54 mL, P = 0.005), andless by CE-2DE (172 ± 58 mL, P = 0.02) or 3DE (177 ±64 mL, P = 0.08), but EDV was comparable by CE-3DE (196 ±69 mL, P = 0.16). Limits of agreement with MRI were similarfor NC-3DE and CE-2DE, with the best results for CE-3D. Resultswere similar for calculation of LVESV. Patients were categorizedinto groups of EF (35, 35–50, >50%) by MRI. NC-2DEdemonstrated a 68% agreement (kappa 0.45, P = 0.001), CE-2DEa 62% agreement (kappa 0.20, P = 136), NC-3DE a 74% agreement(kappa 0.39, P = 0.005) and CE-3DE an 80% agreement (kappa 0.56,P < 0.001). Conclusion: CE-2DE is analogous to NC-3DE in accurate categorization ofLV function. However, CE-3DE is feasible and superior to otherNC- and CE-techniques in patients with previous infarction.