Validation of real-time three-dimensional echocardiography for quantifyingleft ventricular volumes in the presence of a left ventricular aneurysm: In vitro and in vivo studies

OBJECTIVES To validate the accuracy of real-time three-dimensional echocard iography (RT3DE) for quantifying aneurysmal left ventricular (LV) volumes. BACKGROUNDS Conventional two-dimensional echocardiography (2DE) has limitat ions when applied for quantification of LV volumes in patients with LV aneu rysms. METHODS Seven aneurysmal balloons, IS sheep (5 with chronic LV aneurysms an d 10 without LV aneurysms) during 60 different hemodynamic conditions and 2 9 patients (13 with chronic LV aneurysms and 16 with normal LV) underwent R T3DE and 2DE. Electromagnetic flow meters and magnetic resonance imaging (M RI) served as reference standards in the animals and in the patients, respe ctively. Rotated apical six-plane method with multiplanar Simpson's rule an d apical biplane Simpson's rule were used to determine LV volumes by RT3DE and 2DE, respectively. RESULTS Both RT3DE and 2DE correlated well with actual volumes for aneurysm al balloons. However, a significantly smaller mean difference (MD) was foun d between RT3DE and actual volumes (-7 ml for RT3DE vs. 22 ml for 2DE, p = 0.0002). Excellent correlation and agreement between RT3DE and electromagne tic flow meters for LV stroke volumes for animals with aneurysms were obser ved, while 2DE showed lesser correlation and agreement (r = 0.97, MD = -1.0 ml vs. r = 0.76, MD = 4.4 ml). In patients with LV aneurysms, better corre lation and agreement between RT3DE and MRI for LV volumes were obtained (r = 0.99, MD = -28 ml) than between 2DE and MRI (r = 0.91, MD = -49 ml). CONCLUSIONS For geometrically asymmetric LVs associated with ventricular an eurysms, RT3DE can accurately quantify LV volumes. (C) 2000 by the American College of Cardiology.