Three-dimensional echocardiography: assessment of inter- and intra-operator variability and accuracy in the measurement of left ventricular cavity volume and myocardial mass

Accurate left ventricular (LV) volume and mass estimation is a strong predi ctor of cardiovascular morbidity and mortality. We propose that our techniq ue of 3D echocardiography provides an accurate quantification of LV volume and mass by the reconstruction of 2D images into 3D volumes, thus avoiding the need for geometric assumptions. We compared the accuracy and variabilit y in LV volume and mass measurement using 3D echocardiography with 2D echoc ardiography, using in vitro studies. Six operators measured the LV volume a nd mass of seven porcine hearts, using both 3D and 2D techniques. Regressio n analysis was used to test the accuracy of results and an ANOVA lest was u sed to compute variability in measurement. LV volume measurement accuracy w as 9.8% (3D) and 18.4% (2D); LV mass measurement accuracy was 5% (3D) and 9 .2% (2D). Variability in LV volume quantification with 3D echocardiography was %SEMinter = 13.5%, %SEMintra = 11.4%, and for 2D echocardiography was % SEMinter = 21.5%, %SEMintra, = 19.1%. We derived an equation to predict unc ertainty in measurement of LV volume and mass using 3D echocardiography, th e results of which agreed with our experimental results to within 13%. 3D e chocardiography provided twice the accuracy for LV volume and mass measurem ent and half the variability for LV volume measurement as compared with 2D echocardiography.