Gopal A S, Shen Z, Sapin P M, Keller A M, Schnellbaecher M J, Leibowitz D W, Akinboboye O O, Rodney R A, Blood D K, King D L
Columbia University College of Physicians and Surgeons, Division of Cardiology, New York, NY, USA.
Circulation. 1995 Aug 15;92(4):842-53. doi: 10.1161/01.cir.92.4.842.
Reliable, serial, noninvasive quantitative estimation of left ventricular ejection fraction is essential for selecting and timing therapeutic interventions in patients with heart disease. Equilibrium radionuclide angiography is widely used for this purpose but has well-recognized limitations. Advantages of echocardiography over equilibrium radionuclide angiography include assessment of wall motion, valvular pathology, and cardiac hemodynamics, in addition to portability, lack of radiation exposure, and substantially lower cost. However, conventional echocardiographic techniques are limited by geometric assumptions, image positioning errors, and use of subjective visual methods. To overcome these limitations, a three-dimensional echocardiographic method was developed. This study compares ejection fraction by three-dimensional echocardiography, quantitative two-dimensional echocardiography, and subjective two-dimensional echocardiographic visual estimation with that by equilibrium radionuclide angiography.
Fifty-one unselected patients with suspected heart disease underwent left ventricular ejection fraction determination by equilibrium radionuclide angiography and three-dimensional echocardiography using an interactive line-of-intersection display and a new algorithm, ventricular surface reconstruction, for volume computation. In 44 patients, ejection fractions were also estimated visually by experienced observers from two-dimensional echocardiography and by quantitative two-dimensional echocardiography using an apical biplane summation-of-disks algorithm. An excellent correlation was obtained between three-dimensional echocardiography and equilibrium radionuclide angiography (r = .94 to .97, SEE = 3.64% to 5.35%; limits of agreement, 10.3% to 13.3%) without significant underestimation or overestimation. SEE values and limits of agreement were twofold to threefold lower than corresponding values for all two-dimensional echocardiographic techniques. In addition, interobserver variability was significantly lower for the three-dimensional echocardiographic method (10.2%) than for the apical biplane summation-of-disks method (26.1%) and subjective visual estimation (33.3%).
Determination of ejection fraction by three-dimensional echocardiography yields results comparable to those obtained by equilibrium radionuclide angiography and is substantially superior to all two-dimensional echocardiographic methods. Therefore, three-dimensional echocardiography may be used for accurate serial quantification of left ventricular function as an alternative to equilibrium radionuclide angiography.
对心脏病患者选择治疗干预措施并确定其时机而言，可靠、连续且无创的左心室射血分数定量评估至关重要。平衡放射性核素血管造影术广泛用于此目的，但存在公认的局限性。超声心动图相对于平衡放射性核素血管造影术的优势包括评估室壁运动、瓣膜病变和心脏血流动力学，此外还具有便携性、无辐射暴露以及成本大幅降低等优点。然而，传统超声心动图技术受几何假设、图像定位误差以及主观视觉方法应用的限制。为克服这些局限性，研发了一种三维超声心动图方法。本研究比较了三维超声心动图、定量二维超声心动图以及主观二维超声心动图视觉评估法与平衡放射性核素血管造影术测定的射血分数。
51例未经挑选的疑似心脏病患者接受了平衡放射性核素血管造影术及三维超声心动图检查，后者采用交互式交点显示法和一种新算法（心室表面重建法）进行容积计算以测定左心室射血分数。在44例患者中，经验丰富的观察者还通过二维超声心动图进行视觉评估，并采用心尖双平面圆盘求和算法通过定量二维超声心动图进行评估。三维超声心动图与平衡放射性核素血管造影术之间具有极佳的相关性（r = 0.94至0.97，标准误 = 3.64%至5.35%；一致性界限，10.3%至13.3%），无明显低估或高估。标准误值和一致性界限比所有二维超声心动图技术的相应值低两至三倍。此外，三维超声心动图方法的观察者间变异性（10.2%）显著低于心尖双平面圆盘求和法（26.1%）和主观视觉评估法（33.3%）。
三维超声心动图测定射血分数的结果与平衡放射性核素血管造影术相当，且明显优于所有二维超声心动图方法。因此，三维超声心动图可作为平衡放射性核素血管造影术的替代方法，用于准确连续定量评估左心室功能。
