Buck T, Hunold P, Wentz K U, Tkalec W, Nesser H J, Erbel R
Department of Cardiology, University of Essen, Germany.
Circulation. 1997 Dec 16;96(12):4286-97. doi: 10.1161/01.cir.96.12.4286.
Two-dimensional (2D) echocardiographic approaches based on geometric assumptions face the greatest limitations and inaccuracies in patients with left ventricular (LV) aneurysms. Three-dimensional (3D) echocardiographic techniques can potentially overcome these limitations; to date, however, although tested in experimental models of aneurysms, they have not been applied to a series of patients with such distortion. The purpose of this study was therefore to validate the clinical application of tomographic 3D echocardiography (3DE) by the routine transthoracic approach to determine LV chamber size and systolic function without geometric assumptions in patients with LV aneurysms.
In 23 patients with chronic stable LV aneurysms, LV end-systolic and end-diastolic volumes (LVEDV, LVESV) and ejection fraction (LVEF) by tomographic 3DE were compared with results from 3D magnetic resonance tomography (3DMRT) as an independent reference as well as with the conventional techniques of single plane and biplane 2D echocardiography and biplane cineventriculography. Dynamic 3DE image data sets were obtained from a transthoracic apical view with the use of a rotating probe with acquisition gated to control for ECG and respiration (Echoscan, TomTec). Volumes were calculated from the 3D data sets by summating the volumes of multiple parallel disks. 3DE results correlated and agreed well with those by 3DMRT, with better correlation and agreement than provided by other techniques for LVEDV (3DE: r=.97, SEE=14.7 mL, SD of differences from 3DMRT=14.5 mL; other techniques: r=.84 to .93, SEE=30.7 to 41.6 mL [P<.001 versus 3DE by F test], SD of differences=31.5 to 40.7 mL [P<.001 versus 3DE by F test]). The same also pertained to LVESV (3DE: r=.97, SEE=12.4 mL, SD of differences=12.9 mL; other techniques: r=.81 to .90, SEE=24.7 to 37.2 mL [P<.001], SD of differences=27.6 to 36.8 mL [P<.005]) and LVEF (3DE: r=.74, SEE=5.6%, SD of differences=6.7%; other techniques: r=.14 to .59, SEE=9.5% to 10.1% [P<.01], SD of differences=9.5% to 12.6% [P<.05]). Compared with 3DMRT, 3DE was less time consuming and patient discomfort was less.
Tomographic 3DE is an accurate noninvasive technique for calculating LV volumes and systolic function in patients with LV aneurysm. Unlike current 2D methods, tomographic 3DE requires no geometric assumptions that limit accuracy.
基于几何假设的二维（2D）超声心动图方法在左心室（LV）室壁瘤患者中面临最大的局限性和不准确性。三维（3D）超声心动图技术有可能克服这些局限性；然而，迄今为止，尽管已在室壁瘤的实验模型中进行了测试，但尚未应用于一系列存在此类结构变形的患者。因此，本研究的目的是通过常规经胸途径验证断层3D超声心动图（3DE）在确定LV室壁瘤患者的左心室腔大小和收缩功能时无需几何假设的临床应用。
在23例慢性稳定LV室壁瘤患者中，将断层3DE测量的左心室收缩末期和舒张末期容积（LVEDV、LVESV）及射血分数（LVEF）与作为独立参考的3D磁共振断层扫描（3DMRT）结果以及单平面和双平面2D超声心动图及双平面电影心室造影等传统技术的结果进行比较。使用带有旋转探头的经胸心尖视图获取动态3DE图像数据集，并将采集与心电图和呼吸进行门控同步（Echoscan，TomTec）。通过对多个平行圆盘的容积求和，从3D数据集中计算容积。3DE结果与3DMRT结果具有相关性且一致性良好，与其他技术相比，在LVEDV方面具有更好的相关性和一致性（3DE：r = 0.97，标准误 = 14.7 mL，与3DMRT差异的标准差 = 14.5 mL；其他技术：r = 0.84至0.93，标准误 = 30.7至41.6 mL [F检验，与3DE相比P < 0.001]，差异的标准差 = 31.5至40.7 mL [F检验，与3DE相比P < 0.001]）。LVESV和LVEF情况相同（LVESV：3DE：r = 0.97，标准误 = 12.4 mL，差异的标准差 = 12.9 mL；其他技术：r = 0.81至0.90，标准误 = 24.7至37.2 mL [P < 0.001]，差异的标准差 = 27.6至36.8 mL [P < 0.005]；LVEF：3DE：r = 0.74，标准误 = 5.6%，差异的标准差 = 6.7%；其他技术：r = 0.14至0.59，标准误 = 9.5%至10.1% [P < 0.01]，差异的标准差 = 9.5%至12.6% [P < 0.05]）。与3DMRT相比，3DE耗时更少，患者不适感更低。
断层3DE是一种准确的无创技术，用于计算LV室壁瘤患者的左心室容积和收缩功能。与目前的2D方法不同，断层3DE无需限制准确性的几何假设。
