Centro Cardiologico Monzino IRCCS, Milan, Italy.
Centro Cardiologico Monzino IRCCS, Milan, Italy.
J Am Soc Echocardiogr. 2017 Nov;30(11):1049-1058. doi: 10.1016/j.echo.2017.06.026. Epub 2017 Sep 12.
Recently, a new automated software package (HeartModel) was developed to obtain three-dimensional (3D) left ventricular (LV) volumes using a model-based algorithm (MBA) with a "one-button" simple system and user-adjustable slider. The aims of this study were to verify the feasibility and accuracy of the MBA in comparison with other commonly used imaging techniques in a large unselected population, to evaluate possible accuracy improvements of free operator border adjustments or changes of the slider's default position, and to identify differences in method accuracy related to specific pathologies.
This prospective study included consecutive 200 patients. LV volumes and ejection fraction were obtained using the MBA and compared with the two-dimensional biplane method, the 3D full-volume (3DFV) modality, and, in 90 of 200 cases, cardiac magnetic resonance (CMR) measurements. To evaluate the optimal position of the slider with respect to the 3DFV and CMR modalities, a set of threefold cross-validation experiments was performed. Optimized and manually corrected LV volumes obtained using the MBA were also tested. Linear correlation and Bland-Altman analysis were used to assess intertechnique agreement.
Automatic volumes were feasible in 194 patients (94.5%), with a mean processing time of 29 ± 10 sec. MBA-derived volumes correlated significantly with all evaluated methods, with slight overestimation of two-dimensional biplane and slight underestimation of CMR measurements. Higher correlations were found between MBA and 3DFV measurements, with negligible differences both in volumes (overestimation) and in LV ejection fraction (underestimation), respectively. Optimization of the user-adjustable slider position improved the correlation and markedly reduced the bias between the MBA and 3DFV or CMR. The accuracy of MBA volumes was lower in some pathologies for incorrect definition of LV endocardium.
The MBA is highly feasible, reproducible, and rapid, and it correlates highly with the traditional 3DFV method. It may represent a valid alternative to 3DFV measurement for everyday clinical use.
最近，开发了一种新的自动化软件包（HeartModel），该软件包使用基于模型的算法（MBA）和“一键”简单系统以及用户可调节的滑块来获取三维（3D）左心室（LV）容积。本研究的目的是在大型未选择人群中验证 MBA 的可行性和准确性，并比较其他常用成像技术，评估操作员自由调整边界或改变滑块默认位置的准确性提高的可能性，并确定与特定病理学相关的方法准确性差异。
这项前瞻性研究纳入了 200 例连续患者。使用 MBA 获得 LV 容积和射血分数，并与二维双平面法、3D 全容积（3DFV）模式进行比较，并且在 200 例中的 90 例中与心脏磁共振（CMR）测量值进行比较。为了评估滑块相对于 3DFV 和 CMR 模式的最佳位置，进行了一组三倍交叉验证实验。还测试了使用 MBA 获得的优化和手动校正的 LV 容积。使用线性相关和 Bland-Altman 分析评估技术间的一致性。
在 194 例患者（94.5%）中，自动容积是可行的，平均处理时间为 29±10 秒。MBA 衍生的容积与所有评估方法均显著相关，二维双平面法存在轻微高估，CMR 测量值存在轻微低估。MBA 与 3DFV 测量值之间的相关性更高，分别在容积（高估）和 LV 射血分数（低估）方面几乎没有差异。用户可调节滑块位置的优化改善了 MBA 和 3DFV 或 CMR 之间的相关性并显著降低了偏差。对于 LV 心内膜定义不正确的某些病理学，MBA 容积的准确性较低。
MBA 高度可行、可重复且快速，并且与传统的 3DFV 方法高度相关。它可能是日常临床使用中 3DFV 测量的有效替代方法。
