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Feasibility of New Transthoracic Three-Dimensional Echocardiographic Automated Software for Left Heart Chamber Quantification in Children
Journal of the American Society of Echocardiography ( IF 6.5 ) Pub Date : 2018-09-18 , DOI: 10.1016/j.echo.2018.08.001
Romain Amadieu , Khaled Hadeed , Marion Jaffro , Clément Karsenty , Miarisoa Ratsimandresy , Yves Dulac , Philippe Acar

Background

New three-dimensional echocardiographic automated software (HeartModel) is now available to quantify the left heart chambers. The aims of this study were to assess the feasibility, reproducibility, and analysis time of this technique and its correlation with manual three-dimensional echocardiography (3DE) and cardiac magnetic resonance (CMR) in children.

Methods

Ninety-two children (5–17 years of age) were prospectively included in two separate protocols. In protocol 1, 73 healthy children underwent two-dimensional and three-dimensional transthoracic echocardiography. Left ventricular (LV) end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction (LVEF), and left atrial volume at ventricular end-systole (LAV) by automated 3DE were compared with the same measurements obtained using manual 3DE. In protocol 2, automated three-dimensional echocardiographic measurements from 19 children with cardiomyopathy were compared with CMR values.

Results

Automated 3DE was feasible in 77% of data sets and significantly reduced the analysis time compared with manual 3DE. In protocol 1, there were excellent correlations for LVEDV, LVESV, and LAV between automated 3DE and manual 3DE (r = 0.89 to 0.99, P < .0001 for all) and a weak correlation for LVEF, despite contour adjustment (r = 0.57, P < .0001). Automated 3DE overestimated LVEDV, LVEF, and LAV with small biases and underestimated LVESV with wider bias. With contour adjustment, the biases and limits of agreement were reduced (bias: LVEDV, 0.9 mL; LVESV, −1.2 mL; LVEF, 2.2%). In protocol 2, correlations between automated 3DE with contour edit and CMR were good for LV volumes and LAV (r = 0.76 to 0.94, P < .0003 for all) but remained weak for LVEF (r = 0.46, P = .05). Automated 3DE slightly underestimated LV volumes (relative bias, −7.2% to −7.8%) and significantly underestimated LAV (relative bias, −31.6%). The limits of agreement were clinically acceptable only for LVEDV. Finally, test-retest, intraobserver, and interobserver variability values were low (<12%).

Conclusions

HeartModel is feasible, reproducible, faster than manual 3DE, and comparable with manual 3DE for measurements of LV and left atrial volumes in children >5 years of age. However, compared with CMR, only LVEDV measured by automated 3DE with contour edit seems applicable for clinical practice.



中文翻译:

新的经胸三维三维超声心动图自动软件对儿童左心室定量的可行性

背景

现在可以使用新的三维超声心动图自动化软件(HeartModel)来量化左心室。这项研究的目的是评估这项技术的可行性,可重复性和分析时间,以及其与儿童手动三维超声心动图(3DE)和心脏磁共振(CMR)的相关性。

方法

预期将92名儿童(5-17岁)纳入两个单独的方案中。在方案1中,有73名健康儿童接受了二维和三维经胸超声心动图检查。通过自动3DE将左心室舒张末期容积(LVEDV),左室收缩末期容积(LVESV),左室射血分数(LVEF)和左室收缩末期容积(LAV)与相同测量值进行比较使用手册3DE获得。在方案2中,将来自19名心肌病患儿的自动三维超声心动图测量结果与CMR值进行了比较。

结果

与手动3DE相比,自动化3DE在77%的数据集中是可行的,并且大大减少了分析时间。在协议1中,自动3DE和手动3DE之间的LVEDV,LVESV和LAV的相关性极佳(r  = 0.89至0.99, 所有P <.0001),尽管轮廓进行了调整(LV  = 0.57,P  <.0001)。自动化的3DE在偏差较小的情况下高估了LVEDV,LVEF和LAV,在偏差较大的情况下则低估了LVESV。通过轮廓调整,减小了偏差和一致性极限(偏差:LVEDV,0.9 mL; LVESV,-1.2 mL; LVEF,2.2%)。在协议2中,具有轮廓编辑功能的自动3DE与CMR之间的相关性对于LV体积和LAV均很好(r  = 0.76至0.94,P  <.0003,但对于LVEF仍然很弱(r  = 0.46,P  = .05)。自动化的3DE略低估了左室容积(相对偏差,-7.2%至-7.8%),而低估了LAV(相对偏差,-31.6%)。协议的限制在临床上仅适用于LVEDV。最后,重测,观察者内和观察者间的变异性值低(<12%)。

结论

HeartModel是可行的,可重现的,比手动3DE更快,并且可以与手动3DE相比,用于测量5岁以上儿童的LV和左心房容积。但是,与CMR相比,只有通过带有轮廓编辑的自动3DE测量的LVEDV似乎适用于临床实践。

更新日期:2018-09-18
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