Abstract
Objectives: The aim of the present study was to establish the accuracy and reproducibility of left atrial volume measurements by three-dimensional (3D) echocardiography compared to 2D biplane and monoplane measurements. Background: No echocardiographic technique is generally accepted as optimal for estimation of left atrial size. Methods: Left atrial volumes of 18 unselected cardiac patients were obtained with magnetic resonance imaging (MRI) (volumes 145 ± 58 ml). These volumes were compared with those obtained with different echocardiographic methods: a multiplane 3D method based on 90 images acquired by apical probe rotation, a simplified 3D method using only the three standard apical views, and 2D biplane and monoplane methods based on area-length, disc summation and spherical formulas. Results: The echocardiographic methods significantly underestimated maximum left atrial volumes as obtained by MRI by 14–37% (p < 0.001). Accuracy, expressed as 1 SD of individual estimates around this systematic underestimation, was 25 to 27% for all methods, except for the 2D 2-chamber monoplane method (37%). Interobserver coefficient of variation was between 14 and 20% for all methods (n.s.). Conclusion: All echocardiographic methods significantly underestimated left atrial volumes as obtained by MRI. A minor non-significant improvement in individual echocardiographic estimates by the 3D methods was obtained at the cost of more time consumption. In unselected patients ultrasound image quality precludes significant improvement of left atrial volume measurements by the applied 3D methods.
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References
The Stroke Prevention in Atrial Fibrillation Investigators. Predictors of thromboembolism in atrial fibrillation: II. Echocardiographic features of patients at risk. Annals of Internal Medicine 1992; 116: 6-12.
Burwash IG, Blackmore GL, Koilpillai CJ. Usefulness of left atrial and left ventricular chamber sizes as predictors of the severity of mitral regurgitation. American Journal of Cardiology 1992; 70: 774-779.
Benjamin EJ, D'Agostino RB, Belanger AJ, Wolf PA, Levy D. Left atrial size and the risk of stroke and death. The Framingham Heart Study. Circulation 1995; 92: 835-841.
Vasan RS, Larson MG, Levy D, Evans JC, Benjamin EJ. Distribution and categorization of echocardiographic measurements in relation to reference limits: the Framingham Heart Study: formulation of a height-and sex-specific classification and its prospective validation. Circulation 1997; 96: 1863-1873.
Bigger TJJ. Epidemological and Mechanical Studies of Atrial Fibrillation as a Basis for Treatment Strategies. Circulation 1998; pp. 943-945.
Feigenbaum H. Echocardiography. 5th ed.: Philadelphia: Lea & Febiger, 1994; 3, Echocardiographic Evaluation of Cardiac Chambers — Left Atrium. p. 166–169.
Schabelman S, Schiller NB, Silverman NH, Ports TA. Left atrial volume estimation by two-dimensional echocardiography. Catheterization & Cardiovascular Diagnosis 1981; 7: 165-178.
Pattynama PM, Lamb HJ, van der Velde EA, van der Wall EE, de Roos A. Left ventricular measurements with cine and spin-echo MR imaging: a study of reproducibility with variance component analysis. Radiology 1993; 187: 261-268.
Shapiro EP, Rogers WJ, Beyar R, Soulen RL, Zerhouni EA, Lima JA, et al. Determination of left ventricular mass by magnetic resonance imaging in hearts deformed by acute infarction. Circulation 1989; 79: 706-711.
Mogelvang J, Lindvig K, Sondergaard L, Saunamaki K, Henriksen O. Reproducibility of cardiac volume measurements including left ventricular mass determined by MRI. Clinical Physiology 1993; 13: 587-597.
Roelandt JR, ten Cate FJ, Vletter WB, Taams MA. Ultrasonic dynamic three-dimensional visualization of the heart with a multiplane transesophageal imaging transducer. Journal of the American Society of Echocardiography 1994; 7: Pt 1: 217-229.
Salustri A, Spitaels S, McGhie J, Vletter W, Roelandt JR. Transthoracic three-dimensional echocardiography in adult patients with congenital heart disease. Journal or the American College of Cardiology 1995; 26: 759-767.
Salustri A, Roelandt J. Three dimensional reconstruction of the heart with rotational acquisition: methods and clinical applications. British Heart Journal 1995; 73: 10-15.
Aakhus S, Maehle J, Bjoernstad K. A new method for echocardiographic computerized three-dimensional reconstruction of left ventricular endocardial surface: in vitro accuracy and clinical repeatability of volumes. Journal of the American Society of Echocardiography 1994; 7: 571-581.
Maehle J, Bjoernstad K, Aakhus S, Torp HG, Angelsen BAJ. Three-Dimensional Echocardiography for Quantitative Left Ventricular Wall Motion Analyses. Echocardiography 1994; 11(4): 397-408.
Mele D, Maele J, Pedini I, Alboni P, Levine RA. Three-Dimensional Echocardiographic Reconstruction: description and application of a Simplified Technique for Quantitative Assessment of Left Ventricular Size and Function. American Journal of Cardiology 1998; 81: 107G-108G.
Henry WL, DeMaria A, Feigenbaum H, Kerber R, Kisslo J, Weyman AE, et al. Report of The American Society of Echocardiography Committee on Nomenclature and Standards: identification of Myocardial Wall Segments. American Society of Echocardiography 1982.
Rodevand O, Bjornerheim R, Aakhus S, Kjekshus J. Left ventricular volumes assessed by different new three-dimensional echocardiographic methods and ordinary biplane technique. International Journal of Cardiac Imaging 1998; 14: 55-63.
Weyman AE. Principles and Practice of Echocardiography. 2nd ed. Philadelphia: Lea & Febiger, 1994; 18 and 20, Left ventricular inflow tract, Left Ventricle 1: General Considerations, Assessment of Chamber Size and Function. p. 477, 591–592.
Weyman AE. Principles and Practice of Echocardiography. 2nd ed. Philadelphia: Lea & Febiger, 1994; 18 and 20, Left ventricular inflow tract, Left Ventricle 1: General Considerations, Assessment of Chamber Size and Function. p. 477, 592–594.
Weyman AE. Principles and Practice of Echocardiography. 2nd ed. Philadelphia: Lea & Febiger, 1994; 18, Left ventricular inflow tract, left atrial volume. p. 477–478.
Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. Journal of the American Society of Echocardiography 1989; 2: 358-367.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307-310.
Keene ON. The log transformation is special. Statistics in Medicine 1995; 14: 811-819.
Bland JM, Altman DG. Measurement error proportional to the mean. British Medical Journal 1996; 313: 106
Bland JM, Altman DG. Measurement error. British Medical Journal 1996; 312: 1654
Kleinbaum DG, Kupper LL, Muller KE. Applied regression Analyses and Other Multivariable Methods. 2nd ed. Boston: PWS-KENT Publishing Company, 1988; 17, One-Way Analysis of Variance. p. 343,358–361.
Altman DG. Practical statistics for medical research. London: Chapman & Hall, 1991.
Gottdiener JS, Livengood SV, Meyer PS, Chase GA. Should echocardiography be performed to assess effects of antihypertensive therapy? Test-retest reliability of echocardiography for measurement of left ventricular mass and function. Journal of the American College of Cardiology 1995; 25: 424-430.
Himelman RB, Cassidy MM, Landzberg JS, Schiller NB. Reproducibility of quantitative two-dimensional echocardiography. American Heart Journal 1988; 115: 425-431.
Kirscher B, Abbot JA, Stanley P, Gould RB, Himelman RB, Higgins CB, et al. Left atrial volume determination by biplane two-dimensional echocardiography: Validation by cine computed tomography. American Heart Journal 1991; 121: 864-871.
Vandenberg BF, Weiss RM, Kinzey J, Acker M, Stark CA, Stanford W, et al. Comparison of left atrial volume by two-dimensional echocardiography and cine-computed tomography. American Journal of Cardiology 1995; 75: 754-757.
Jarvinen V, Kupari M, Hekali P, Poutanen VP. Assessment of left atrial volumes and phasic function using cine magnetic resonance imaging in normal subjects. American Journal of Cardiology 1994; 73: 1135-1138.
Vogel M, Gutberlet M, Dittrich S, Hosten N, Lange PE. Comparison of transthoracic three dimensional echocardiography with magnetic resonance imaging in the assessment of right ventricular volume and mass. Heart 1997; 78: 127-130.
Weyman AE. Principles and Practice of Echocardiography. 2nd ed. Philadelphia: Lea & Febiger, 1994; Appendix A, Normal Cross-Sectional Echocardiographic Measurements. p. 1292
Pini R, Giannazzo G, Di Bari M, Innocenti F, Rega L, Casolo G, et al. Transthoracic three-dimensional echocardiographic reconstruction of left and right ventricles: in vitro validation and comparison with magnetic resonance imaging. American Heart Journal 1997; 133: 221-229.
Nosir YF, Stoker J, Kasprzak JD, Lequin MH, Dall'Agata A, ten Cate FJ, et al. Paraplane analysis from precordial three-dimensional echocardiographic data sets for rapid and accurate quantification of left ventricular volume and function: a comparison with magnetic resonance imaging. American Heart Journal 1999; 137: 134-143.
Nosir YF, Lequin MH, Kasprzak JD, van Domburg RT, Vletter WB, Yao J, et al. Measurements and day-to-day variabilities of left ventricular volumes and ejection fraction by three-dimensional echocardiography and comparison with magnetic resonance imaging. American Journal of Cardiology 1998; 82: 209-214.
Sakuma H, Globits S, Bourne MW, Shimakawa A, Foo TK, Higgins CB. Improved reproducibility in measuring LV volumes and mass using multicoil breath-hold cine MR imaging. Journal of Magnetic Resonance Imaging 1996; 6: 124-127.
Handschumacher MD, Lethor JP, Siu SC, Mele D, Rivera JM, Picard MH, et al. A new integrated system for three-dimensional echocardiographic reconstruction: development and validation for ventricular volume with application in human subjects. Journal of the American College of Cardiology 1993; 21: 743-753.
King DL, Gopal AS, Keller AM, Sapin PM, Schroder KM. Three-dimensional echocardiography. Advances for measurement of ventricular volume and mass. Hypertension 1994; 23: 172-179.
King DL, Harrison MR, King DL, Jr., Gopal AS, Martin RP, DeMaria AN. Improved reproducibility of left atrial and left ventricular measurements by guided three-dimensional echocardiography. Journal of the American College of Cardiology 1992; 20: 1238-1245.
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Rodevand, O., Bjornerheim, R., Ljosland, M. et al. Left atrial volumes assessed by three- and two-dimensional echocardiography compared to MRI estimates. Int J Cardiovasc Imaging 15, 397–410 (1999). https://doi.org/10.1023/A:1006276513186
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DOI: https://doi.org/10.1023/A:1006276513186