Barletta Valentina, Hinojar Rocio, Carbonell Alejandra, González-Gómez Ariana, Fabiani Iacopo, Di Bello Vitantonio, Jiménez-Nacher José Julio, Zamorano José, Fernández-Golfín Covadonga
Cardiac Vascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Cardiac Imaging Unit, Cardiology Department, Ramón y Cajal University Hospital, Madrid, Spain.
Int J Cardiovasc Imaging. 2018 Aug;34(8):1205-1213. doi: 10.1007/s10554-018-1336-y. Epub 2018 Mar 31.
Left ventricular systolic function evaluation is an essential part of all transthoracic echocardiographic (TTE) studies. 3D echocardiography (3DE) is superior to 2D and is recommended as the method of choice. However, since it is time consuming and requires training, it is rarely performed. Different automatic analysis software tries to overcome these limitations but they need to be accurate and reproducible before they can be used clinically. The aim of this study was to test the accuracy and reproducibility of new 3D automatic quantitative software in everyday clinical practice. 69 patients referred to our Echo Lab for a clinically indicated echocardiographic examination were included. All patients underwent a full TTE with 3D image acquisition. Left ventricular volumes and ejection fraction (LVEF) were obtained using Heart Model software, and compared with conventional 3D volumetric data. Automated analysis was performed using three different sliders setting, with or without regional editing if necessary. 20 patients underwent a cardiac magnetic resonance (CMR) study the same day of the echo and automated measurements were also compared with a CMR reference. Intra- and inter-technique comparisons including linear regression with Pearson correlation coefficients and Bland-Altman analyses were calculated. Mean age of the patients was 59 years, with 49.3% male. The automated 3DE model demonstrated excellent correlation with the conventional 3DE measurements of LVEF, using three different sliders settings (r = 0.906; r = 0.898 and r = 0.940). Correlations with CMR values were very good as well (r = 0.888; r = 0.869; r = 0.913). Similarly, no significant differences were noted between the values of EDV and ESV, measured with the automated model or CMR, with excellent correlation (EDV: r = 0.892, r = 0.842, 0.910; ESV: r = 0.925, r = 0.860, r = 0.907). Finally, volumes calculated with the automated software were significantly greater than those obtained manually, but they showed a very good correlation (EDV: r = 0.875, r = 0.856, r = 0.891; ESV: r = 0.929, r = 0.879, r = 949). 3D automatic software for LV quantification is feasible and shows excellent correlations with both CMR and 3D echocardiography, considered the gold standard. No clinically relevant differences were noted when applying different border settings. This technique holds promise to facilitate the integration of 3D TTE into clinical practice.
左心室收缩功能评估是所有经胸超声心动图（TTE）检查的重要组成部分。三维超声心动图（3DE）优于二维超声心动图，被推荐为首选方法。然而，由于其耗时且需要培训，很少被采用。不同的自动分析软件试图克服这些局限性，但在临床应用前需要确保其准确性和可重复性。本研究的目的是在日常临床实践中测试新型三维自动定量软件的准确性和可重复性。纳入了69名因临床需要转诊至我们超声心动图实验室进行超声心动图检查的患者。所有患者均接受了完整的TTE检查并采集了三维图像。使用心脏模型软件获取左心室容积和射血分数（LVEF），并与传统的三维容积数据进行比较。使用三种不同的滑块设置进行自动分析，必要时可进行区域编辑。20名患者在超声检查当天还接受了心脏磁共振（CMR）检查，自动测量结果也与CMR参考值进行了比较。计算了包括Pearson相关系数的线性回归和Bland-Altman分析在内的技术内和技术间比较。患者的平均年龄为59岁，男性占49.3%。使用三种不同的滑块设置，自动三维超声心动图模型与LVEF的传统三维超声心动图测量结果显示出极佳的相关性（r = 0.906；r = 0.898；r = 0.940）。与CMR值的相关性也非常好（r = 0.888；r = 0.869；r = 0.913）。同样，使用自动模型或CMR测量的舒张末期容积（EDV）和收缩末期容积（ESV）值之间未发现显著差异，相关性极佳（EDV：r = 0.892，r = 0.842，0.910；ESV：r = 0.925，r = 0.860，r = 0.907）。最后，自动软件计算的容积明显大于手动获得的容积，但它们显示出非常好的相关性（EDV：r = 0.875，r = 0.856，r = 0.891；ESV：r = 0.929，r = 0.879，r = 0.949）。用于左心室定量的三维自动软件是可行的，与CMR和三维超声心动图（被视为金标准）均显示出极佳的相关性。应用不同的边界设置时未发现临床相关差异。这项技术有望促进三维TTE在临床实践中的应用。
