title: Diagnostic value of three-dimensional contrast-enhanced echocardiography for left ventricular volume and ejection fraction measurement in patients with poor acoustic windows: a comparison of echocardiography and magnetic resonance imaging.
abstract: BACKGROUND
  Three-dimensional echocardiography (3DE) is a reliable and reproducible tool for assessing left ventricular (LV) function but remains sensitive to patient echogenicity. Contrast-enhanced 3DE (C3DE) has the potential to improve quantification in challenging patients. The aim of this study was to evaluate the impact of temporal resolution, spatial resolution, and image dynamic range on LV function assessed using C3DE compared with cardiac magnetic resonance imaging (MRI) in patients with poor echogenicity.
  
  
  METHODS
  Forty-one patients with poor echogenicity who underwent two-dimensional echocardiography (2DE), 3DE, C3DE, and MRI were retrospectively investigated.
  
  
  RESULTS
  Before contrast injection, 24 patients had three or more nonvisible segments. Three cases of 2DE and 12 cases of 3DE were not suitable for quantification. LV end-diastolic volumes were systematically underestimated by 2DE (142 ± 58 mL), 3DE (146 ± 69 mL), and C3DE (172 ± 61 mL) compared with MRI (216 ± 85 mL) (P < .001). Similar results were found for LV end-systolic volumes (81 ± 65 mL for 2DE, 82 ± 69 mL for 3DE, and 102 ± 80 mL for C3DE vs 129 ± 94 mL for MRI; P < .001). C3DE provided the best agreement with MRI (Lin concordance correlation coefficients of 0.67, 0.93, and 0.99, respectively, for end-diastolic volume, end-systolic volume, and ejection fraction) as well as the best measurement reproducibility. Finally, ultrasound settings had no significant effect on LV volumes and ejection fraction measurements.
  
  
  CONCLUSIONS
  In these patients with poor ultrasound image quality, C3DE, regardless of instrument settings, outperformed 2DE and 3DE to assess LV volumes and ejection fraction and can thus be proposed as an acceptable alternative when MRI cannot be performed in this subgroup.
authors: Department of Cardiology, CHU de Caen, Caen, France; EA 4650, Université de Caen Basse-Normandie, Caen, France. Electronic address: saloux-e@chu-caen.fr.
authors: Eric
authors: E
authors: Saloux
authors: Department of Cardiology, CHU de Caen, Caen, France.
authors: Fabien
authors: F
authors: Labombarda
authors: Department of Cardiology, CHU de Caen, Caen, France.
authors: Arnaud
authors: A
authors: Pellissier
authors: Department of Cardiology, CHU de Caen, Caen, France.
authors: Bruno
authors: B
authors: Anthune
authors: Department of Biostatistics and Clinical Research, CHU de Caen, Caen, France.
authors: Audrey Emmanuelle
authors: AE
authors: Dugué
authors: Department of Radiology, CHU de Caen, Caen, France.
authors: Nicole
authors: N
authors: Provost
authors: Medisys Philips Research, Paris, France.
authors: Pascal
authors: P
authors: Allain
authors: Medisys Philips Research, Paris, France.
authors: Mathieu
authors: M
authors: De Craene
authors: Department of Cardiology, CHU de Caen, Caen, France; EA 4650, Université de Caen Basse-Normandie, Caen, France.
authors: Paul
authors: P
authors: Milliez
authors: EA 4650, Université de Caen Basse-Normandie, Caen, France; Department of Imaging, CHU de Caen and GIP CYCERON, Caen, France.
authors: Alain
authors: A
authors: Manrique
mesh_terms: D000465:Algorithms; D003287:Contrast Media; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013459:Sulfur Hexafluoride; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis*
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: Cardiac magnetic resonance; Three-dimensional contrast-enhanced echocardiography; Three-dimensional echocardiography