title: Three-dimensional echocardiography for the preoperative assessment of patients with left ventricular aneurysm.
abstract: BACKGROUND
  Surgical ventricular reconstruction has been proposed as a treatment option in heart failure patients with left ventricular (LV) aneurysm. The feasibility of this procedure has some limitations, and extensive preoperative evaluation is necessary to give the correct indication. For this purpose, magnetic resonance imaging (MRI) is currently considered the gold standard, providing accurate quantification of LV shape, size, and global and regional function together with the assessment of myocardial scar and mitral regurgitation severity. The aim of this study was to evaluate the accuracy of real-time three-dimensional echocardiography (RT3DE) as a potential alternative to MRI for this evaluation.
  
  
  METHODS
  A total of 52 patients with ischemic cardiomyopathy and LV aneurysm underwent a comprehensive analysis with two-dimensional echocardiography, RT3DE, and MRI.
  
  
  RESULTS
  Excellent correlation (r=0.97, p<0.001) and agreement were found between RT3DE and MRI for quantification of LV volumes, ejection fraction, and sphericity index; in a segment-to-segment comparison, RT3DE was shown to be accurate also for the analysis of wall motion abnormalities (k=0.62) and LV regional thickness (k=0.56) as a marker of myocardial scar. In contrast, two-dimensional echocardiography significantly underestimated these variables. Furthermore, mitral regurgitant volume assessed by RT3DE showed excellent correlation (r=0.93) with regurgitant volume measured by MRI, without significant bias (=-0.7 mL/beat).
  
  
  CONCLUSIONS
  In the management of heart failure patients with LV aneurysm, RT3DE provides an accurate and comprehensive assessment, including quantification of LV size, shape, global systolic function, regional wall motion, and myocardial scar together with precise evaluation of the severity of mitral regurgitation.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, the Netherlands.
authors.forename: Nina Ajmone
authors.initials: NA
authors.lastname: Marsan
authors.forename: Jos J M
authors.initials: JJ
authors.lastname: Westenberg
authors.forename: Stijntje D
authors.initials: SD
authors.lastname: Roes
authors.forename: Rutger J
authors.initials: RJ
authors.lastname: van Bommel
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Rob J
authors.initials: RJ
authors.lastname: van der Geest
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Klautz
authors.forename: Johan C
authors.initials: JC
authors.lastname: Reiber
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
mesh_terms: D000368:Aged; D019560:Echocardiography, Three-Dimensional; D005240:Feasibility Studies; D005260:Female; D006322:Heart Aneurysm / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D006352:Heart Ventricles; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D011300:Preoperative Care; D015203:Reproducibility of Results; D013318:Stroke Volume; D020257:Ventricular Remodeling