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Assessment of left atrial functional parameters using a novel dedicated analysis tool for real-time three-dimensional echocardiography: validation in comparison to magnetic resonance imaging

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Abstract

Real-time three-dimensional echocardiography (RT3DE) is superior to two-dimensional echocardiography in assessing left atrial (LA) parameters, but to date algorithms developed for the left ventricle were applied due to a lack of dedicated LA software. In addition, no data are available on RT3DE assessment of active atrial contraction. The aim of this study was to validate a novel RT3DE analysis tool specifically dedicated to evaluate the LA. Cardiac magnetic resonance imaging (MRI) served as standard of reference. Fifty-five patients scheduled for pulmonary vein isolation underwent cardiac MRI and RT3DE. On ultrasound image datasets, a dynamic polyhedron model of the LA was generated from which LA maximum and minimum volumes (LAmax and LAmin), passive atrial emptying fraction (LAEF), and active atrial ejection fraction (LAEFtrue) were derived and compared to values obtained from cardiac MRI. High intraclass correlations between RT3DE and MRI were found for LAmax (r = 0.94, p < 0.001), LAmin (r = 0.95, p < 0.001), LAEF (r = 0.92, p < 0.001), and LAEFtrue (r = 0.87, p < 0.001). Similarly, Bland–Altman analysis revealed narrow limits of agreement for LAmax (−28.6 to 14.1 ml), LAmin (−26.8 to 12.4 ml), LAEF (−11.2 to 14.9 %), and LAEFtrue (−10.6 to 6.8 %). LAmax, LAmin and LAEFtrue were measured significantly (p < 0.05) lower by RT3DE (111 ± 38 ml vs. 118 ± 39 ml, 73 ± 38 ml vs. 80 ± 41 ml, and 23 ± 14 % vs. 27 ± 14 %, respectively). Interobserver and intraobserver RT3DE measurements correlated closely. RT3DE using a novel dedicated software tool is valid, accurate and reproducible for assessing LA dimensional and functional parameters. This study corroborates previous reports and extends its validity to the assessment of active LA contraction.

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Acknowledgments

The software package (4D LA Analysis©) for RT3DE analysis used in this study was provided free of charge by TomTec Imaging Systems, Unterschleissheim, Germany.

Disclosures

We wish to acknowledge that the patient population analysed in the present study is shared with another scientific work currently under peer-review with a different journal. In contrast to the present study which aims at validation particularly of the active component of atrial ejection, the second study compares various two-dimensional and three-dimensional echocardiographic methods for LA volume analysis (but not LAEFtrue) with MRI serving as standard of reference. Of note, the same 3DRTE and MRI acquisitions used in the present study were also included into the other study. However, offline-analysis of raw datasets was independently performed for both works. Thus, while certain methodological aspects are identical for both, the studies’ backgrounds, results, scope and conclusions differ substantially.

Conflict of interest

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Authors and Affiliations

  1. Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Ronny R. Buechel, Gregor Leibundgut, Andreas Rohner, Florian Riede, Arnheid Kessel-Schaefer, Beat A. Kaufmann, Michael J. Zellweger & Michael Handke

  2. Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Gregor Sommer & Jens Bremerich

  3. Division of Cardiology, Basel University Medical Clinic, Rheinstrasse 26, 4410, Liestal, Switzerland

    Michael Handke

Authors
  1. Ronny R. Buechel
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  2. Gregor Sommer
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  3. Gregor Leibundgut
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  4. Andreas Rohner
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  5. Florian Riede
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  6. Arnheid Kessel-Schaefer
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  7. Beat A. Kaufmann
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  8. Michael J. Zellweger
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  9. Jens Bremerich
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  10. Michael Handke
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Corresponding author

Correspondence to Ronny R. Buechel.

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Buechel, R.R., Sommer, G., Leibundgut, G. et al. Assessment of left atrial functional parameters using a novel dedicated analysis tool for real-time three-dimensional echocardiography: validation in comparison to magnetic resonance imaging. Int J Cardiovasc Imaging 29, 601–608 (2013). https://doi.org/10.1007/s10554-012-0127-0

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  • DOI: https://doi.org/10.1007/s10554-012-0127-0

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