Feasibility of single-beat full-volume capture real-time three-dimensional echocardiography and auto-contouring algorithm for quantification of left ventricular volume: validation with cardiac magnetic resonance imaging

Background: With recent developments in echocardiographic technology, a new system using real-time three-dimensional echocardiography (RT3DE) that allows single-beat acquisition of the entire volume of the left ventricle and incorporates algorithms for automated border detection has been introduced. Provided that these techniques are acceptably reliable, three-dimensional echocardiography may be much more useful for clinical practice. The aim of this study was to evaluate the feasibility and accuracy of left ventricular (LV) volume measurements by RT3DE using the single-beat full-volume capture technique.

Methods: One hundred nine consecutive patients scheduled for cardiac magnetic resonance imaging and RT3DE using the single-beat full-volume capture technique on the same day were recruited. LV end-systolic volume, end-diastolic volume, and ejection fraction were measured using an auto-contouring algorithm from data acquired on RT3DE. The data were compared with the same measurements obtained using cardiac magnetic resonance imaging.

Results: Volume measurements on RT3DE with single-beat full-volume capture were feasible in 84% of patients. Both interobserver and intraobserver variability of three-dimensional measurements of end-systolic and end-diastolic volumes showed excellent agreement. Pearson's correlation analysis showed a close correlation of end-systolic and end-diastolic volumes between RT3DE and cardiac magnetic resonance imaging (r = 0.94 and r = 0.91, respectively, P < .0001 for both). Bland-Altman analysis showed reasonable limits of agreement. After application of the auto-contouring algorithm, the rate of successful auto-contouring (cases requiring minimal manual corrections) was <50%.

Conclusions: RT3DE using single-beat full-volume capture is an easy and reliable technique to assess LV volume and systolic function in clinical practice. However, the image quality and low frame rate still limit its application for dilated left ventricles, and the automated volume analysis program needs more development to make it clinically efficacious.