Semi‐automated estimation of left ventricular ejection fraction by two‐dimensional and three‐dimensional echocardiography is feasible, time‐efficient, and reproducible

Myhr, Katrine Aagaard; Pedersen, Frederik H. G.; Kristensen, Charlotte Burup; Visby, Lasse; Hassager, Christian; Møgelvang, Rasmus

doi:10.1111/echo.14112

Cited by 9 publications

(8 citation statements)

References 36 publications

(78 reference statements)

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“…This novel method does not require specific training and has substantially less post-processing analysis time than 3DE (Table S8 , Supplementary data). Time-efficacy may be even further improved by applying simultaneous bi-plane acquisition 33 , which most vendors provide already. Once integrated with the vendor specific echocardiographic analysis software, our novel method will provide an automated LVM, comparable to LVM by 3DE or CMR and with high reproducibility.…”

Section: Discussionmentioning

confidence: 99%

A new method to quantify left ventricular mass by 2D echocardiography

Kristensen

Myhr

Grund

et al. 2022

Sci Rep

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Increased left ventricular mass (LVM) is a strong independent predictor for adverse cardiovascular events, but conventional echocardiographic methods are limited by poor reproducibility and accuracy. We developed a novel method based on adding the mean wall thickness from the parasternal short axis view, to the left ventricular end-diastolic volume acquired using the biplane model of discs. The participants (n = 85) had various left ventricular geometries and were assessed using echocardiography followed immediately by cardiac magnetic resonance, as reference. We compared our novel two-dimensional (2D) method to various conventional one-dimensional (1D) and other 2D methods as well as the three-dimensional (3D) method. Our novel method had better reproducibility in intra-examiner [coefficients of variation (CV) 9% vs. 11–14%] and inter-examiner analysis (CV 9% vs. 10–20%). Accuracy was similar to the 3D method (mean difference ± 95% limits of agreement, CV): Novel: 2 ± 50 g, 15% vs. 3D: 2 ± 51 g, 16%; and better than the “linear” 1D method by Devereux (7 ± 76 g, 23%). Our novel method is simple, has considerable better reproducibility and accuracy than conventional “linear” 1D methods, and similar accuracy as the 3D-method. As the biplane model forms part of the standard echocardiographic protocol, it does not require specific training and provides a supplement to the modern echocardiographic report.

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Section: Discussionmentioning

confidence: 99%

A new method to quantify left ventricular mass by 2D echocardiography

Kristensen

Myhr

Grund

et al. 2022

Sci Rep

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“…Single-beat acquisitions are feasible and have been shown to provide values similar to those obtained using multi-beat acquisition [13][14][15] A semi-automated algorithm for endocardial border detection is now available in commercially available echo machines provided by major vendors ( Figure 1A and IB). This has been showed to be feasible, time-efficient and reproducible in LV volumes and ejection measurements [16,17]. A recent study showed inter-vendor consistency of measurement of LV volumes and ejection fraction as compared with CMR.…”

Section: Left Ventricular Volumetric and Functional Assessmentmentioning

confidence: 93%

3D Echo in Routine Clinical Practice – State of the Art in 2019

Poon

Leung

2019

Heart, Lung and Circulation

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Since its first description in the 1960s, three-dimensional echocardiography (3D echo) has gone through major advances. Initially, 3D echo was performed by acquiring a series of two-dimensional (2D) tomographic images, either by manual rotation of the transducer with external references or later by multi-plane transoesophageal echocardiography (TOE). Three-dimensional echo images were then generated by off-line reconstruction. The process was cumbersome and time consuming, thereby precluding its use in routine clinical practice. Through advances in ultrasound, electronic and computer technologies, real time display of 3D rendered images of the heart is possible with both transthoracic echo and TOE, enabling its more widespread use in routine clinical practice. Numerous studies have demonstrated the utility and, in many cases, the superiority of 3D over 2D echo in the assessment of almost all cardiac structures and function. These include assessment of left ventricular (LV) and right ventricular (RV) volume and function and wall motion, left and right atrial volume, LV mass, valvular heart disease, congenital heart disease, LV synchrony, guidance of interventional procedures and in volumetric colour Doppler imaging. In this article, we do not aim to give a full review of the technical aspects and all possible applications of 3D echo. Instead, we focus on areas where, in our opinions, 3D echo should be used in routine clinical practice in 2019. Three-dimensional (3D) echo has been around for almost five decades. Recent advances in ultrasound, electronic and computing technologies have moved 3D echo from the research environment to everyday clinical practice. Real time 3D echo and full volume acquisition are now possible with transthoracic as well as transoesophageal probes. The main advantages of 3D echo are the infinite cut planes possible, allowing direct, en face, and anatomical views of cardiac structures, avoiding foreshortening and circumventing the geometric assumptions of the cardiac chambers inherent in any 2D echo techniques. Three-dimensional echo is still dependent on image quality, subjected to ultrasound artifacts and faces the compromise between spatial and temporal resolution. In routine clinical practice in 2019, we recommend a focussed 3D examination after a full 2D echo study. The area where 3D echo has been consistently shown to have superior accuracy and reproducibility over 2D echo is in the assessment of left ventricular (LV) volumes and ejection fraction. We recommend obtaining a full volume 3D echo data set from the apical window, from which LV volumes and LV global longitudinal strain can be measured. Further 3D examination can be performed depending on the pathologies identified on 2D examination. Three-dimensional echo is superior to 2D echo in the assessment of mitral valve pathologies and atrial septal defects. Furthermore, real time 3D transoesophageal echo is a very useful technique in guiding structural cardiac intervention, both before, during and after the procedure. While 3D echo...

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“…Anatomical assumptions are another source of errors. Although SBR works sufficiently well for simple LV geometries with little to no heterogeneity, it does not perform robustly under severe anatomical variations ( Myhr et al 2018 ). First, SBR assumes that the basal plane is perfectly perpendicular to the apicobasal direction that defines the disks, but LV anatomies have different degrees of basal slanting, which occurs when the basal plane is no longer perpendicular to the long axis in one or both views simultaneously.…”

Section: Methodsmentioning

confidence: 99%

“…We have only two vertical longitudinal contours with which to estimate LV volume. The inherent inaccuracies from such assumptions are inevitable owing to the limited dimensionality of the data ( Myhr et al 2018 ).…”

Section: Methodsmentioning

confidence: 99%