Archive for the ‘Echocardiography’ Category

Journal Club 23 October 2013


Feasibility of Single-Beat Full-Volume Capture Real-Time Three-Dimensional Echocardiography and Auto-Contouring Algorithm for Quantification of Left Ventricular Volume: Validation with Cardiac Magnetic Resonance Imaging





With recent developments in echocardiographic technology, a new system using real-time threedimensional
echocardiography (RT3DE) that allows single-beat acquisition of the entire volume of the left
ventricle and incorporates algorithms for automated border detection has been introduced. Provided that
these techniques are acceptably reliable, three-dimensional echocardiography may be much more useful
for clinical practice. The aim of this study was to evaluate the feasibility and accuracy of left ventricular (LV)
volume measurements by RT3DE using the single-beat full-volume capture technique.


One hundred nine consecutive patients scheduled for cardiac magnetic resonance imaging and RT3DE
using the single-beat full-volume capture technique on the same day were recruited. LV end-systolic volume, enddiastolic
volume, and ejection fraction were measured using an auto-contouring algorithm from data acquired on
RT3DE.Thedatawerecomparedwiththe samemeasurementsobtainedusingcardiacmagnetic resonance imaging.
Results: Volume measurements on RT3DE with single-beat full-volume capture were feasible in 84% of patients.
Both interobserver and intraobserver variability of three-dimensional measurements of end-systolic
and end-diastolic volumes showed excellent agreement. Pearson’s correlation analysis showed a close correlation
of end-systolic and end-diastolic volumes between RT3DE and cardiac magnetic resonance imaging
(r = 0.94 and r = 0.91, respectively, P < .0001 for both). Bland-Altman analysis showed reasonable limits of
agreement. After application of the auto-contouring algorithm, the rate of successful auto-contouring (cases
requiring minimal man
ual corrections) was <50%.


RT3DE using single-beat full-volume capture is an easy and reliable technique to assess LV volume
and systolic function in clinical practice. However, the image quality and low frame rate still limit its
application for dilated left ventricles, and the automated volume analysis program needs more development
to make it clinically efficacious.


Some recent papers in Heart Lung and Circulation are hyperlinked below.






Journal Club 18 July 2012


Echocardiographic Evaluation of Hemodynamics in Patients With Decompensated Systolic Heart Failure





Consecutive patients with decompensated heart failure had simultaneous assessment of left ventricular
and right ventricular hemodynamics invasively and by Doppler echocardiography. In 79 patients, the noninvasive
measurements of stroke volume (r0.83, P0.001), pulmonary artery systolic (r0.83, P0.001) and diastolic pressure
(r0.51, P0.009), and mean right atrial pressure (r0.85, P0.001) all had significant correlations with invasively acquired measurements. Several Doppler indices had good accuracy in identifying patients with pulmonary capillary wedge pressure 15 mm Hg (area under the curve, 0.86 to 0.92). The recent American Society of Echocardiography/European Association of Echocardiography guidelines were highly accurate (sensitivity, 98%; specificity, 91%) in identifying patients with increased wedge pressure. In 12 repeat studies, Doppler echocardiography readily detected the changes in mean wedge pressure (r0.75, P0.005) as well as changes in pulmonary artery systolic pressure and mean right atrial pressure.


Doppler echocardiography provides reliable assessment of right and left ventricular hemodynamics in
patients with decompensated heart failure.


  • A number of participants observed the paucity of evidence supporting routine assessment of hemodynamics in guiding therapy for chronic heart failure (including papers by Lynne Warner Stevenson).
  • The consistent relationship of hemodynamics  and prognosis was noted
  • The paper choice was motivated by a planned research project
  • The chpice of LVEDP pre-a wave for comparison with non-invasive data was noted to be largely based on expert opinion and would also be looked at in proposed study

Echocardiographic assessment of diastolic function

A useful presentation is found here.