Association of outcome with left ventricular volumes and ejection fraction measured with two- and three-dimensional echocardiography in patients referred for routine, clinically indicated studies

Abstract

ObjectivesWe sought to analyze if left ventricular (LV) volumes and ejection fraction (EF) measured by three-dimensional echocardiography (3DE) have incremental prognostic value over measurements obtained from two-dimensional echocardiography (2DE) in patients referred to a high-volume echocardiography laboratory for routine, clinically-indicated studies.MethodsWe measured LV volumes and EF using both 2DE and 3DE in 725 consecutive patients (67% men; 59 ± 18 years) with various clinical indications referred for a routine clinical study.ResultsLV volumes were significantly larger, and EF was lower when measured by 3DE than 2DE. During follow-up (3.6 ± 1.2 years), 111 (15.3%) all-cause deaths and 248 (34.2%) cardiac hospitalizations occurred. Larger LV volumes and lower EF were associated with worse outcome independent of age, creatinine, hemoglobin, atrial fibrillation, and ischemic heart diseases). In stepwise Cox regression analyses, the associations of both death and cardiac hospitalization with clinical data (CD: age, creatinine, hemoglobin, atrial fibrillation, and ischemic heart disease) whose Harrel’s C-index (HC) was 0.775, were augmented more by the LV volumes and EF obtained by 3DE than by 2DE parameters. The association of CD with death was not affected by LV end-diastolic volume (EDV) either measured by 2DE or 3DE. Conversely, it was incremented by 3DE LVEF (HC = 0.84, p < 0.001) more than 2DE LVEF (HC = 0.814, p < 0.001). The association of CD with the composite endpoint (HC = 0.64, p = 0.002) was augmented more by 3DE LV EDV (HC = 0.786, p < 0.001), end-systolic volume (HC = 0.801, p < 0.001), and EF (HC = 0.84, p < 0.001) than by the correspondent 2DE parameters (HC = 0.786, HC = 0.796, and 0.84, all p < 0.001) In addition, partition values for mild, moderate and severe reduction of the LVEF measured by 3DE showed a higher discriminative power than those measured by 2DE for cardiac death (Log-Rank: χ2 = 98.3 vs. χ2 = 77.1; p < 0.001). Finally, LV dilation defined according to the 3DE threshold values showed higher discriminatory power and prognostic value for death than when using 2DE reference values (3DE LVEDV: χ2 = 15.9, p < 0.001 vs. χ2 = 10.8, p = 0.001; 3DE LVESV: χ2 = 24.4, p < 0.001 vs. χ2 = 17.4, p = 0.001).ConclusionIn patients who underwent routine, clinically-indicated echocardiography, 3DE LVEF and ESV showed stronger association with outcome than the corresponding 2DE parameters.

Valid and Reproducible Quantitative Assessment of Cardiac Volumes by Echocardiography in Patients with Valvular Heart Diseases—Possible or Wishful Thinking?

“…Then, even comparability between 2D and 3D echocardiography can be assumed if spatial and temporal resolution of 3D data sets are sufficient, echocardiographic views are standardized, endocardial surface rendering is performed properly ( Figure 1 ), and algorithms of 3D echocardiography reflect the true distances. Clearly, 3D echocardiography is the modality of choice for proper assessment of cardiac volumes under pathological conditions [ 54 , 55 , 56 , 57 , 58 , 59 , 60 ].…”

Use of Three-Dimensional Echocardiography in the Analysis of Ventricular Function in Chagas Disease

“…Furthermore, the partition values for mild, moderate, and severe reduction in LV systolic function on the 3D method demonstrated greater discriminatory power for cardiac death than the 2D values, and LV dilation defined by 3D volume showed a greater association with mortality. 21 In addition to the absolute assessment of ventricular volumes and 3D LVEF, it is also possible to obtain a volumetime curve corresponding to the dynamic changes in LV volume during the cardiac cycle. 22 Analysis of this curve makes it possible to assess new non-invasive parameters of ventricular performance, such as maximum systolic flow, peak flow during early LV filling, and peak flow during left atrial contraction.…”

Emprego do Ecocardiograma Tridimensional na Análise de Função Ventricular na Doença de Chagas

“…Além disso, os valores de partição para redução leve, moderada e acentuada da função sistólica do VE por 3D demonstraram maior poder discriminatório para morte cardíaca do que os valores por 2D e a dilatação do VE definida pelo volume 3D apresentou maior associação com mortalidade. 21 Além da avaliação absoluta dos volumes ventriculares e da FEVE 3D, também é possível obter uma curva volumetempo correspondente às alterações dinâmicas no volume ventricular esquerdo durante o ciclo cardíaco. 22 A análise desta curva permite a avaliação de novos parâmetros não invasivos de performance ventricular, como o fluxo sistólico máximo, o fluxo de pico durante o enchimento ventricular esquerdo precoce e o fluxo de pico durante a contração atrial esquerda.…”