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Assessment of left ventricular volume and function by integration of simplified 3D echocardiography, tissue harmonic imaging and automated extraction of endocardial borders

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Abstract

Background: Quantitative Three-dimensional echocardiography (3DEcho) of left ventricle (LV) is still limited because of the need for manually tracing endocardial borders: this can increase observer variability depending on the quality of fundamental (FUND) 2D images. We tested the combination of a simplified 3DEcho technique for LV reconstruction with automated endocardial border detection (Digital Echo Quantification, DEQ) and tissue harmonic imaging (THI) for enhancement of endocardium-cavity interface. Methods: Twenty-five consecutive patients with ischaemic heart disease and dilated or distorted LV underwent 3DEcho and gated-SPECT nuclear examinations evaluating:(a) end-diastolic and end-systolic volumes (EDV, ESV); (b) ejection fraction (EF); (c) volume/time curve (VTC). Thereafter, 3DEcho was applied to 47 patients with acute myocardial infarction (AMI) at pre-discharge and 6 months to evaluate remodelling. Results: Integrated 3DEcho values in THI modality were obtained in 84% of patients and correlated well with nuclear data for EDV (r= 0.95, mean difference =−2.2 ± 15.8 ml), ESV (r= 0.98, mean difference =−3.5 ± 10.2 ml), and EF (r= 0.82, mean difference = 0.6 ± 6.4%; all mean differences NS vs. 0), with an interobserver variability of 4.9, 5.7 and 8.2% for EDV, ESV and EF respectively. Automated VTC by 3DEcho in THI modality reproduced well that obtained by nuclear technique (r= 0.96) and allowed recognition of LV remodelling in 36% of patients at 6 months. Integrated 3DEcho values in FUND modality were obtained only in 52% of patients and showed much higher errors and interobserver variability. Conclusions: THI permits accurate 3D reconstruction of LV borders detected by DEQ, allowing automated VTC throughout the cardiac cycle as well as study of LV remodelling.

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Authors and Affiliations

  1. Institute of Cardiology Azienda Ospedaliera Universitaria, Ferrara, Italy

    Donato Mele, Roberta Teoli, Corrado Cittanti, Giovanni Pasanisi, Gabriele Guardigli & Roberto Ferrari

  2. Noninvasive Cardiac Laboratory, Massachusetts General Hospital-Harvard Medical School, Boston, USA

    Robert A. Levine

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  1. Donato Mele
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  2. Roberta Teoli
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  3. Corrado Cittanti
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  4. Giovanni Pasanisi
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  5. Gabriele Guardigli
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  6. Robert A. Levine
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  7. Roberto Ferrari
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Mele, D., Teoli, R., Cittanti, C. et al. Assessment of left ventricular volume and function by integration of simplified 3D echocardiography, tissue harmonic imaging and automated extraction of endocardial borders. Int J Cardiovasc Imaging 20, 191–202 (2004). https://doi.org/10.1023/B:CAIM.0000021948.96454.3a

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