Contrast-enhanced versus non-enhanced three-dimensional echocardiography of left ventricular volumes

Abstract

Contrast-enhanced versus non-enhanced three-dimensional echocardiography of left ventricular volumesBackground. In three-dimensional echocardiography (3DE), individual endocardial trabeculae are not clearly visible necessitating left ventricular (LV) volumes to be measured by tracing the innermost endocardial contour. Ultrasound contrast agents aim to improve endocardial definition, but may delineate the outermost endocardial contour by filling up intertrabecular space. Although measurement reproducibility may benefit, there may be a significant influence on absolute LV volume measurements. Methods. Twenty patients with a recent myocardial infarction and good ultrasound image quality underwent 3DE using the TomTec Freehand method before and during continuous intravenous contrast infusion. LV volumes were measured offline using TomTec Echo-Scan software. Results. The use of contrast enhancement increased end-diastolic (110±35 vs. 144±53 ml; p<0.01) and end-systolic volume measurements (68±31 vs. 87±45 ml; p<0.01) significantly compared with non-contrast; the ejection fraction remained unchanged (40±13 vs. 41±14%, p=NS). Measurement reproducibility did not improve significantly, however. Conclusion. Volumes measured by 3DE are significantly larger when ultrasound contrast is used. Possibly, intertrabecular space comprises a substantial part of the LV cavity. In the presence of an adequate apical acoustic window, ultrasound contrast does not improve LV volume measurement reproducibility. (Neth Heart J 2008;16:47-52.)

Evaluation of left ventricular structure and function by three-dimensional echocardiography

“…In most publications, 3DTTE has been shown to slightly underestimate both end-diastolic (EDVs) and end-systolic volumes (ESVs). Although these findings are generally consistent with the literature, one caveat is that only two of the included studies used echocardiographic contrast [25,26], which has been shown to improve accuracy of RT3DTTE volumes and ejection fraction compared with a CMR standard [25,27,28]. Among the few studies that did not exclude patients for poor image quality, the negative volume biases were slightly larger: À28.8 AE 38 ml, À17.9 AE 34 ml, and þ0.3 AE 15.5% for EDV, ESV, and ejection fraction, respectively.…”

Comparison of Left Ventricular Stroke Volume Assessment by Two‐ and Three‐Dimensional Echocardiography in a Swine Model of Acute Myocardial Infarction Validated by Thermodilution Method

“…Use of contrast agents was not included in the original study because previous studies have shown that it may lead to overestimation of the volumes and it sometimes suppressed cardiac function in the pigs in our previous experiments. 16 The findings of this study should be validated in humans before applied to clinical practice as discussed above, especially in critically ill patients where the acoustic imaging is limited in a different way than pigs.…”

“…Though its contribution is considered relatively small because the measurements were performed immediately after creating myocardial infarction, it might have contributed partially to the overestimation of SV by echocardiography compared with TDM. Use of contrast agents was not included in the original study because previous studies have shown that it may lead to overestimation of the volumes and it sometimes suppressed cardiac function in the pigs in our previous experiments 16 . The findings of this study should be validated in humans before applied to clinical practice as discussed above, especially in critically ill patients where the acoustic imaging is limited in a different way than pigs.…”