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Direct Measurement of Left Ventricular Outflow Tract Area Using Three‐Dimensional Echocardiography in Biplane Mode Improves Accuracy of Stroke Volume Assessment
Author(s) -
Shahgaldi Kambiz,
Manouras Aristomenis,
Brodin LarsÅke,
Winter Reidar
Publication year - 2010
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/j.1540-8175.2010.01197.x
Subject(s) - biplane , ventricular outflow tract , stroke volume , medicine , mean difference , nuclear medicine , significant difference , gold standard (test) , limits of agreement , cardiology , ejection fraction , heart failure , materials science , confidence interval , composite material
Aims: The aim of the study was to investigate whether left ventricular stroke volume (LVSV) assessment using direct measurement of left ventricular outflow tract area (LVOT A ) is superior to conventional methods for SV calculation. Methods and results: Thirty patients were included in the study (39 ± 12 years). LVSV was assessed by multiplying LVOT velocity time integral (VTI) by LVOT A provided by direct planimetrical measurements from real time three‐dimensional echocardiography (RT3DE) in biplane mode (SV 2 ). These measurements were compared to conventional methods using either the LVOT diameter for LVOT A multiplied with VTI (SV 1 ) or biplane Simpson (SV 3 ). Direct SV measurements by RT3DE were used as gold standard (SV ref ). There was an excellent correlation and agreement between SV determined by SV 2 and 3DE (r = 0.98, mean difference 0.5 ± 3.3 mL). However, the concordance of the traditional methods (SV 1 and SV 3 ) with 3DE was weaker (r = 0.38, mean difference −2.0 ± 17.6 mL, r = 0.84, mean difference −7.6 ± 8.7 mL, respectively). Furthermore, cardiac output (CO) measurements performed by the different modalities were not concordant with wide limits of agreement, except by SV 2 the mean difference of CO by SV 1 was −0.12 ± 1.05 L/min, 0.03 ± 0.20 L/min by SV 2 , and −0.45 ± 0.52 L/min by SV 3 . Conclusions: SV and CO calculations using direct measurement of LVOT area is a feasible, accurate and reproducible method and correlates extremely well with 3DE volume measurements. SV and CO calculation by LVOT A is therefore an appealing method for LVSV assessment in clinical routine. (Echocardiography 2010;27:1078‐1085)