Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
J Cardiol. 2023 Jan;81(1):19-25. doi: 10.1016/j.jjcc.2022.08.007. Epub 2022 Sep 2.
Although transthoracic three-dimensional echocardiography (3DE) is now recommended by guidelines for left ventricular (LV) volumetric measurements, widespread implementation has been limited due to time constraints and required expertise. We hypothesized that fully automated 3DE left chamber quantification software might provide accurate measurements, and that its application could eliminate these obstacles.
To address this hypothesis, we conducted a systematic review and meta-analysis following a search for studies that compared LV volumes and ejection fraction (EF) using fully automated 3DE software (HeartModel or Dynamic HeartModel, Philips Healthcare, Andover, MA, USA) with cardiac magnetic resonance (CMR), from 2015 to 2021. A random effects model was used to determine biases, correlations, and 95 % confidence intervals (CI) of LV end-diastolic volume (EDV), end-systolic volume (ESV), and EF. Subgroup and meta-regression analyses were performed to determine effects of moderators on the outcome.
Of 12 studies (616 subjects), mean differences and 95 % CIs in EDV, ESV, and EF between fully automated 3DE software and CMR were -19.6 mL (95 % CI; -27.6 to -11.5 mL), -11.4 mL (-16.7 to -6.2 mL), and 0.4 % (-1.1 to 2.0 %), respectively. Corresponding correlation values between the two methods were 0.91 (0.86-0.94), 0.89 (0.82-0.93), and 0.85 (0.81-0.88), respectively. Meta-regression analysis revealed that there were no effects of either publication year, type of software, or type of analysis on the outcome of LV volumetric and functional parameters except for publication year on LVESV correlation values.
Although 3DE still underestimates LV volumes, the observed differences were no >20 mL. EF showed similar values to CMR. Excellent correlations between the two techniques make fully automated 3DE left chamber quantification software useful for routine clinical practice in adult population.
尽管指南现在推荐经胸三维超声心动图（3DE）用于左心室（LV）容积测量，但由于时间限制和所需专业知识，其广泛应用受到限制。我们假设全自动 3DE 左室定量软件可能提供准确的测量值，并且其应用可以消除这些障碍。
为了验证这一假设，我们进行了一项系统评价和荟萃分析，对 2015 年至 2021 年期间使用全自动 3DE 软件（荷兰皇家飞利浦电子公司的 HeartModel 或 Dynamic HeartModel）与心脏磁共振（CMR）比较 LV 容积和射血分数（EF）的研究进行了搜索。使用随机效应模型确定 LV 舒张末期容积（EDV）、收缩末期容积（ESV）和 EF 的偏倚、相关性和 95%置信区间（CI）。进行亚组和荟萃回归分析以确定对结果的调节因素的影响。
在 12 项研究（616 例患者）中，全自动 3DE 软件与 CMR 之间 EDV、ESV 和 EF 的平均差异和 95%CI 分别为-19.6mL（95%CI：-27.6 至-11.5mL）、-11.4mL（-16.7 至-6.2mL）和 0.4%（-1.1 至 2.0%）。两种方法之间的相应相关值分别为 0.91（0.86-0.94）、0.89（0.82-0.93）和 0.85（0.81-0.88）。荟萃回归分析表明，除 LVESV 相关性值的出版年份外，出版年份、软件类型或分析类型对 LV 容积和功能参数的结果均无影响。
尽管 3DE 仍然低估了 LV 容积，但观察到的差异不超过 20mL。EF 与 CMR 显示出相似的值。两种技术之间的极好相关性使得全自动 3DE 左室定量软件在成年人群的常规临床实践中具有实用价值。
