Three-dimensional echocardiographic quantification of the left-heart chambers using an automated adaptive analytics algorithm: multicentre validation study.
Although recommended by current guidelines, adoption of three-dimensional echocardiographic (3DE) chamber quantification in clinical practice has lagged because of time-consuming analysis. We recently validated an automated algorithm that measures left atrial (LA) and left ventricular (LV) volumes and ejection fraction (EF). This study aimed to determine the accuracy and reproducibility of these measurements in a multicentre setting.



180 patients underwent 3DE imaging (Philips) at six sites. Images were analysed using automated HeartModel (HM) software with endocardial border correction when necessary and by manual tracing. Measurements were performed by each site and by the Core Laboratory (CL) as the reference. Inter-technique comparisons included HM measurements by the sites against manual tracing by CL, and showed strong correlations (r-values: LVEDV: 0.97, LVESV: 0.97, LVEF: 0.88, LAV: 0.96), with the automated technique slightly underestimating LV volumes (biases: LVEDV: -14 ± 20 ml, LVESV: -6 ± 20 ml), LVEF (-2 ± 7%) and LAV (-9 ± 10 ml). Intra-technique comparisons included HM measurements by the sites against CL, with and without corrections. Corrections were unnecessary or minimal in most patients, and improved the measurements only modestly. Comparisons without corrections showed perfect agreement for all parameters. With corrections, correlations were better (r-values: LVEDV: 0.99, LVESV: 0.99, LVEF: 0.94, LAV: 0.99) and biases (LVEDV: -8 ± 12 ml, LVESV: -6 ± 12 ml, LVEF: 1 ± 5%, LAV: -10 ± 6 ml) smaller than in inter-technique comparison. All automated measurements with corrections were more reproducible than manual measurements.



Automated 3DE analysis of left-heart chambers is an accurate alternative to conventional manual methodology, which yields almost the same values across laboratories and is more reproducible. This technique may contribute towards full integration of 3DE quantification into clinical routine.
University of Chicago, Medical Center, Chicago, Illinois, USA.
Diego
D
Medvedofsky
University of Chicago, Medical Center, Chicago, Illinois, USA.
Victor
V
Mor-Avi
Saint-Luc University Hospital, Brussels, Belgium.
Mihaela
M
Amzulescu
University Hospital Ramón y Cajal, Madrid, Spain.
Covadonga
C
Fernández-Golfín
University Hospital Ramón y Cajal, Madrid, Spain.
Rocio
R
Hinojar
King's College Hospital, London, UK.
Mark J
MJ
Monaghan
University of Occupational and Environmental Health, Kitakyushu, Japan.
Kyoko
K
Otani
King's College Hospital, London, UK.
Joseph
J
Reiken
University of Occupational and Environmental Health, Kitakyushu, Japan.
Masaaki
M
Takeuchi
Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Wendy
W
Tsang
Saint-Luc University Hospital, Brussels, Belgium.
Jean-Louis
JL
Vanoverschelde
King's College Hospital, London, UK.
Mathivathana
M
Indrajith
University of Chicago, Medical Center, Chicago, Illinois, USA.
Lynn
L
Weinert
University Hospital Ramón y Cajal, Madrid, Spain.
Jose Luis
JL
Zamorano
University of Chicago, Medical Center, Chicago, Illinois, USA.
Roberto M
RM
Lang
D000328:Adult; D000465:Algorithms; D016279:Atrial Function, Left / Q000502:physiology; D001331:Automation; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology
3D echocardiography; automated analysis; cardiac chamber quantification; multicentre study