Clinical Research
Cardiac Imaging
Performance of 3-Dimensional Echocardiography in Measuring Left Ventricular Volumes and Ejection Fraction: A Systematic Review and Meta-Analysis

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Objectives

The primary aim of this systematic review is to objectively evaluate the test performance characteristics of three-dimensional echocardiography (3DE) in measuring left ventricular (LV) volumes and ejection fraction (EF).

Background

Despite its growing use in clinical laboratories, the accuracy of 3DE has not been studied on a large scale. It is unclear if this technology offers an advantage over traditional two-dimensional (2D) methods.

Methods

We searched for studies that compared LV volumes and EF measured by 3DE and cardiac magnetic resonance (CMR) imaging. A subset of those also compared standard 2D methods with CMR. We used meta-analyses to determine the overall bias and limits of agreement of LV end-diastolic volume (EDV), end-systolic volume (ESV), and EF measured by 3DE and 2D echocardiography (2DE).

Results

Twenty-three studies (1,638 echocardiograms) were included. The pooled biases ± 2 SDs for 3DE were −19.1 ± 34.2 ml, −10.1 ± 29.7 ml, and − 0.6 ± 11.8% for EDV, ESV, and EF, respectively. Nine studies also included data from 2DE, where the pooled biases were −48.2 ± 55.9 ml, −27.7 ± 45.7 ml, and 0.1 ± 13.9% for EDV, ESV, and EF, respectively. In this subset, the difference in bias between 3DE and 2D volumes was statistically significant (p = 0.01 for both EDV and ESV). The difference in variance was statistically significant (p < 0.001) for all 3 measurements.

Conclusions

Three-dimensional echocardiography underestimates volumes and has wide limits of agreement, but compared with traditional 2D methods in these carefully performed studies, 3DE is more accurate for volumes and more precise in all 3 measurements.

Key Words

ejection fraction
left ventricular volumes
meta-analysis
real-time three-dimensional echocardiography
systematic review

Abbreviations and Acronyms

2D
two-dimensional
2DE
two-dimensional echocardiography
3D
three-dimensional
3DE
three-dimensional echocardiography
BA
Bland-Altman
CMR
cardiac magnetic resonance
EDV
end-diastolic volume
EF
ejection fraction
ESV
end-systolic volume
LV
left ventricular

Cited by (0)

Dr. Allen is a consultant for Amgen. Dr. Salcedo serves as a consultant with Philips Medical Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.