Quantification of regional left ventricular wall motion from real-time 3-dimensional echocardiography in patients with poor acoustic windows: effects of contrast enhancement tested against cardiac magnetic resonance.
OBJECTIVE
Regional left ventricular function can be assessed by real-time 3-dimensional echocardiography (RT3DE) in patients with good image quality. Our goals were to: (1) test the feasibility of RT3DE quantification of regional wall motion (RWM) in patients with poor acoustic windows who require contrast for endocardial visualization; and (2) validate these measurements against cardiac magnetic resonance (CMR) reference.


METHODS
RT3DE datasets and CMR images were obtained in 24 patients. In 16 of 24 patients with suboptimal endocardial definition, RT3DE imaging was repeated with intravenous contrast and triggering at end systole and end diastole. RT3DE datasets were analyzed using custom software designed to semiautomatically detect and segment the endocardial surface and calculate RWM values. CMR images were analyzed using commercial software to obtain reference values for RWM.


RESULTS
In 8 of 24 patients with good endocardial definition, RT3DE values of RWM correlated well with CMR (r = 0.73) with a small bias (-1.0 mm). In the remaining 16 patients, analysis of nonenhanced RT3DE datasets yielded lower correlation with CMR (r = 0.61) and a slightly greater bias (-1.5 mm). The agreement with CMR improved significantly (r = 0.76, bias -1.1 mm) with contrast enhancement.


CONCLUSIONS
The agreement between RT3DE and CMR values of RWM is directly related to RT3DE image quality. In patients with poor acoustic windows, dual-triggered contrast enhancement improves the accuracy of RWM quantification to a level similar to that noted in patients with good images without contrast.
Corsi
Cristiana
C
University of Chicago Medical Center, Chicago, Illinois 60637, USA.
Coon
Patrick
P
Goonewardena
Sascha
S
Weinert
Lynn
L
Sugeng
Lissa
L
Polonsky
Tamar S
TS
Veronesi
Federico
F
Caiani
Enrico G
EG
Lamberti
Claudio
C
Bardo
Dianna
D
Lang
Roberto M
RM
Mor-Avi
Victor
V
D003199:Computer Systems; D004452:Echocardiography / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009068:Movement; D009200:Myocardial Contraction; D009206:Myocardium / Q000473:pathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*