Transthoracic 3D Echocardiographic Left Heart Chamber Quantification Using an Automated Adaptive Analytics Algorithm.
The goal of this study was to test the feasibility and accuracy of an automated algorithm that simultaneously quantifies 3-dimensional (3D) transthoracic echocardiography (TTE)-derived left atrial (LA) and left ventricular (LV) volumes and left ventricular ejection fraction (LVEF). Conventional manual 3D TTE tracings and cardiac magnetic resonance (CMR) images were used as a reference for comparison.



Cardiac chamber quantification from 3D TTE is superior to 2D TTE measurements. However, integration of 3D quantification into clinical practice has been limited by time-consuming workflow and the need for 3D expertise. A novel automated software was developed that provides LV and LA volumetric quantification from 3D TTE datasets that reflect real-life manual 3-dimensional echocardiography measurements and values comparable to CMR.



A total of 159 patients were studied in 2 separate protocols. In protocol 1, 94 patients underwent 3D TTE imaging (EPIQ, iE33, X5-1, Philips Healthcare, Andover, Massachusetts) covering the left atrium and left ventricle. LA and LV volumes and LVEF were obtained using the automated software (HeartModel, Philips Healthcare) with and without contour correction, and compared with the averaged manual 3D volumetric measurements from 3 readers. In protocol 2, automated measurements from 65 patients were compared with a CMR reference. The Pearson correlation coefficient, Bland-Altman analysis, and paired Student t tests were used to assess inter-technique agreement.



Correlations between the automated and manual 3D TTE measurements were strong (r = 0.87 to 0.96). LVEF was underestimated and automated LV end-diastolic, LV end-systolic, and LA volumes were overestimated compared with manual measurements. Agreement between the automated analysis and CMR was also strong (r = 0.84 to 0.95). Test-retest variability was low.



Automated simultaneous quantification of LA and LV volumes and LVEF is feasible and requires minimal 3D software analysis training. The automated measurements are not only comparable to manual measurements but also to CMR. This technique is highly reproducible and timesaving, and it therefore promises to facilitate the integration of 3D TTE-based left-heart chamber quantification into clinical practice.
Division of Cardiology, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; University of Chicago Medical Center, Chicago, Illinois.
Wendy
W
Tsang
Philips Healthcare, Andover, Massachusetts.
Ivan S
IS
Salgo
University of Chicago Medical Center, Chicago, Illinois.
Diego
D
Medvedofsky
University of Chicago Medical Center, Chicago, Illinois.
Masaaki
M
Takeuchi
Philips Healthcare, Andover, Massachusetts.
David
D
Prater
University of Chicago Medical Center, Chicago, Illinois.
Lynn
L
Weinert
University of Chicago Medical Center, Chicago, Illinois.
Megan
M
Yamat
University of Chicago Medical Center, Chicago, Illinois.
Victor
V
Mor-Avi
University of Chicago Medical Center, Chicago, Illinois.
Amit R
AR
Patel
University of Chicago Medical Center, Chicago, Illinois. Electronic address: rlang@medicine.bsd.uchicago.edu.
Roberto M
RM
Lang
D000328:Adult; D000368:Aged; D000465:Algorithms; D016279:Atrial Function, Left; D001331:Automation; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016277:Ventricular Function, Left; D057188:Workflow
3-dimensional echocardiography; automation; cardiac chamber quantification