ASSESSMENT OF CARDIAC-FUNCTION BY 3-DIMENSIONAL ECHOCARDIOGRAPHY COMPARED WITH CONVENTIONAL NONINVASIVE METHODS
ASSESSMENT OF CARDIAC-FUNCTION BY 3-DIMENSIONAL ECHOCARDIOGRAPHY COMPARED WITH CONVENTIONAL NONINVASIVE METHODS
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DOI：
10.1161/01.cir.92.4.842
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发表时间：
1995-08-15
期刊：
影响因子：
37.8
通讯作者：
KING, DL
中科院分区：
文献类型：
--
作者：
GOPAL, AS;SHEN, ZQ;KING, DL
背景可靠的、连续的、无创性的左心室射血分数的定量评估对于心脏病患者的治疗措施的选择和时机选择至关重要。平衡放射性核素血管造影术被广泛用于这一目的，但也有公认的局限性。超声心动图与平衡法放射性核素血管造影术相比的优势包括评估室壁运动、瓣膜病理和心脏血流动力学，此外，还便于携带，不受辐射照射，成本大大降低。然而，传统的超声心动图技术受到几何假设、图像定位误差和主观视觉方法的使用的限制。为了克服这些局限性，开发了一种三维超声心动图方法。方法与结果51例疑似心脏病患者接受了平衡核素心血管造影和三维超声心动图测定的左心室射血分数，三维超声心动图采用交互交线显示和一种新的计算容量的新算法--心室表面重建。在44名患者中，有经验的观察者也通过二维超声心动图和使用心尖双平面圆盘总和算法的定量二维超声心动图来直观地估计射血分数。三维超声心动图与平衡核素血管造影的相关性良好(r=0.94~0.97，SEE=3.64%~5.35%；符合度10.3%~13.3%)，无明显低估或高估。与所有二维超声心动图技术的对应值相比，SEE值和符合度限值低两到三倍。此外，三维超声心动图方法的观察者间变异性(10.2%)显著低于心尖双平面圆盘总和法(26.1%)和主观视觉估计法(33.3%)。结论三维超声心动图测定射血分数的结果与平衡法核素心血管造影结果相当，明显优于所有二维超声心动图方法。因此，三维超声心动图可作为平衡法核素血管造影术的替代方法，用于准确的连续定量测定左心功能。
Background Reliable, serial, noninvasive quantitative estimation of left ventricular ejection fraction is essential for selecting and timing therapeutic interventions in patients with heart disease. Equilibrium radionuclide angiography is widely used for this purpose but has well-recognized limitations. Advantages of echocardiography over equilibrium radionuclide angiography include assessment of wall motion, valvular pathology, and cardiac hemodynamics, in addition to portability, lack of radiation exposure, and substantially lower cost. However, conventional echocardiographic techniques are limited by geometric assumptions, image positioning errors, and use of subjective visual methods. To overcome these limitations, a three-dimensional echocardiographic method was developed. This study compares ejection fraction by three-dimensional echocardiography, quantitative two-dimensional echocardiography, and subjective two-dimensional echocardiographic visual estimation with that by equilibrium radionuclide angiography.Methods and Results Fifty-one unselected patients with suspected heart disease underwent left ventricular ejection fraction determination by equilibrium radionuclide angiography and three-dimensional echocardiography using an interactive line-of-intersection display and a new algorithm, ventricular surface reconstruction, for volume computation. In 44 patients, ejection fractions were also estimated visually by experienced observers from two-dimensional echocardiography and by quantitative two-dimensional echocardiography using an apical biplane summation-of-disks algorithm. An excellent correlation was obtained between three-dimensional echocardiography and equilibrium radionuclide angiography (r =.94 to .97, SEE=3.64% to 5.35%; limits of agreement, 10.3% to 13.3%) without significant underestimation or overestimation. SEE values and limits of agreement were twofold to threefold lower than corresponding values for all two-dimensional echocardiographic techniques. In addition, interobserver variability was significantly lower for the three-dimensional echocardiographic method (10.2%) than for the apical biplane summation-of-disks method (26.1%) and subjective visual estimation (33.3%).Conclusions Determination of ejection fraction by three-dimensional echocardiography yields results comparable to those obtained by equilibrium radionuclide angiography and is substantially superior to all two-dimensional echocardiographic methods. Therefore, three-dimensional echocardiography may be used for accurate serial quantification of left ventricular function as an alternative to equilibrium radionuclide angiography.