Analysis of global systolic and diastolic left ventricular performance using volume-time curves by real-time three-dimensional echocardiography.
BACKGROUND
Left ventricular (LV) volume-time curves (VTC) have been described to provide quantitative data on the dynamics of global LV performance beyond ejection fraction. However, generation of VTCs by conventional 2-dimensional imaging techniques is inherently limited because of inaccurate geometric volume assumptions. We, therefore, studied whether the new concept of volumetric scanning as realized by real-time 3-dimensional echocardiography (RT-3DE) can be used to provide accurate VTCs.


METHODS
In 30 healthy participants, VTCs were generated from 18 to 24 absolute LV volumes per second by transthoracic RT-3DE and compared with magnetic resonance imaging (MRI) used for reference. LVs were traced manually in 9 to 11 parallel, short-axis planes and volumes calculated by disk method. From VTCs, we determined peak ejection rate (PER), peak early filling rate (PFR), time to PER and PFR, and end-diastolic and end-systolic volumes. For initial clinical application, 2 patient groups of coronary (n = 15) and hypertensive heart disease (n = 16) were studied.


RESULTS
In healthy participants, VTCs agreed with MRI (mean errors: PER, -39 +/- 67 mL/s; PFR, -18 +/- 84 mL/s; time to PER, 8 +/- 21 milliseconds; time to PFR 4 +/- 18 milliseconds [not significant vs 0]) whereas VTCs in coronary and hypertensive groups revealed significantly impaired diastolic function. Scanning time for VTCs was only 1 to 2 minutes by RT-3DE and 8 +/- 2 minutes by MRI (P <.001) and time for offline analysis was 22 +/- 5 minutes versus 24 +/- 4 minutes by MRI (not significant).


CONCLUSIONS
Generation of VTCs by RT-3DE is feasible and shows excellent agreement with MRI used for reference. Thus, VTCs by RT-3DE is a promising new approach providing access to quantitative information on global LV performance such as LV filling rates that is currently unavailable for the cardiologist.
Zeidan
Ziad
Z
Department of Cardiology, University Clinic Essen, Hufelandstrasse 55, 45122 Essen, Germany.
Erbel
Raimund
R
Barkhausen
Joerg
J
Hunold
Peter
P
Bartel
Thomas
T
Buck
Thomas
T
D000328:Adult; D000368:Aged; D003199:Computer Systems; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology; D003971:Diastole / Q000502:physiology; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012016:Reference Values; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole / Q000502:physiology; D013997:Time Factors; D016276:Ventricular Function; D016277:Ventricular Function, Left / Q000502:physiology*