Real-Time Three-Dimensional Echocardiographic Acquisition and Quantification of Left Ventricular Indices in Children and Young Adults with Congenital Heart Disease: Comparison with Magnetic Resonance Imaging

Background Echocardiographic assessment of left ventricular (LV) contractility and dimensions is important in the management of patients with congenital heart disease. Conventional two-dimensional measures are limited because of volume or pressure-overloaded right ventricles that may distort the septal planes. Real-time three-dimensional echocardiography (RT3DE) has overcome these limitations; however, postprocessing image reconstruction and analysis are required. We compared LV indices calculated by new online RT3DE software with those obtained by magnetic resonance imaging (MRI) in patients with congenital heart disease. Methods Twelve patients (ages 1-33 years, median age = 15.9 years) with congenital heart disease underwent RT3DE and cardiac MRI. End-diastolic and end-systolic LV volumes, stroke volume, ejection fraction, and mass were calculated online using biplane method-of-discs and semiautomated border detection echocardiographic techniques. Results All RT3DE volumes correlated strongly with MRI ( r = 0.93-0.99, P < .001). Ejection fraction had a lower correlation ( r = 0.69, P = .013). There was no significant underestimation or overestimation of MRI values by RT3DE. Both biplane method-of-discs and semiautomated border detection echocardiographic techniques had excellent volume correlation ( r = 0.94-0.99, P < .001). Interobserver variability was 7%. Conclusions Combined RT3DE acquisition and analysis machines can accurately assess the LV in patients with congenital heart disease, thus impacting clinical management and perhaps obviating the need for MRI in some cases.