@article {Rigollie000388, author = {Marzia Rigolli and Sulakchanan Anandabaskaran and Jonathan P Christiansen and Gillian A Whalley}, title = {Bias associated with left ventricular quantification by multimodality imaging: a systematic review and meta-analysis}, volume = {3}, number = {1}, elocation-id = {e000388}, year = {2016}, doi = {10.1136/openhrt-2015-000388}, publisher = {Archives of Disease in childhood}, abstract = {Purpose Cardiac MR (CMR) is the gold standard for left ventricular (LV) quantification. However, two-dimensional echocardiography (2DE) is the most common approach, and both three-dimensional echocardiography (3DE) and multidetector CT (MDCT) are increasingly available. The clinical significance and interchangeability of these modalities remains under-investigated. Therefore, we undertook a systemic review to evaluate the accuracy and absolute bias in LV quantification of all the commonly available non-invasive imaging modalities (2DE, CE-2DE, 3DE, MDCT) compared to cardiac MR (CMR).Methods Studies were included that reported LV echocardiographic (2DE, CE-2DE, 3DE) and/or MDCT measurements compared to CMR. Only modern CMR (SSFP sequences) was considered. Studies involving small sample size (\<10 patients) and unusual cardiac geometry (ie, congenital heart diseases) were excluded. We evaluated LV end-diastolic volume (LVEDV), end-systolic volume (LVESV) and ejection fraction (LVEF).Results 1604 articles were initially considered: 65 studies were included (total of 4032 scans (echo, CT, MRI) performed in 2888 patients). Compared to CMR, significant biased underestimation of LV volumes with 2DE was seen (LVEDV{\textemdash}33.30 mL, LVESV -16.20 mL, p\<0.0001). This difference was reduced but remained significant with CE-2DE (LVEDV -18.05, p\<0.0001) and 3DE (LVEDV -14.41, p\<0.001), while MDCT values were similar to CMR (LVEDV -1.20, p=0.43; LVESV -0.13, p=0.91). However, excellent agreement for echocardiographic LVEF evaluation (2DE LVEF 0.78{\textendash}1.01\%, p=0.37) was observed, especially with 3DE (LVEF 0.14\%, p=0.88).Conclusions Comparing imaging modalities to CMR as reference standard, 3DE had the highest accuracy in LVEF estimation: 2DE and 3DE-derived LV volumes were significantly underestimated. Newer generation CT showed excellent accuracy for LV volumes.}, URL = {https://openheart.bmj.com/content/3/1/e000388}, eprint = {https://openheart.bmj.com/content/3/1/e000388.full.pdf}, journal = {Open Heart} }