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Three-dimensional echocardiography of the athlete’s heart: a comparison with cardiac magnetic resonance imaging

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Abstract

Three-dimensional echocardiography (3DE) is the most accurate cardiac ultrasound technique to assess cardiac structure. 3DE has shown close correlation with cardiac magnetic resonance imaging (CMR) in various populations. There is limited data on the accuracy of 3DE in athletes and its value in detecting alterations during follow-up. Indexed left and right ventricular end-diastolic volume (LVEDVi, RVEDVi), end-systolic volume, ejection fraction (LVEF, RVEF) and left ventricular mass (LVMi) were assessed by 3DE and CMR in two-hundred and one competitive endurance athletes (79% male) from the Pro@Heart trial. Sixty-four athletes were assessed at 2 year follow-up. Linear regression and Bland–Altman analyses compared 3DE and CMR at baseline and follow-up. Interquartile analysis evaluated the agreement as cardiac volumes and mass increase. 3DE showed strong correlation with CMR (LVEDVi r = 0.91, LVEF r = 0.85, LVMi r = 0.84, RVEDVi r = 0.84, RVEF r = 0.86 p < 0.001). At follow up, the percentage change by 3DE and CMR were similar (∆LVEDVi r = 0.96 bias − 0.3%, ∆LVEF r = 0.94, bias 0.7%, ∆LVMi r = 0.94 bias 0.8%, ∆RVESVi r = 0.93, bias 1.2%, ∆RVEF r = 0.87 bias 0.4%). 3DE underestimated volumes (LVEDVi bias − 18.5 mL/m2, RVEDVi bias − 25.5 mL/m2) and the degree of underestimation increased with larger dimensions (Q1vsQ4 LVEDVi relative bias − 14.5 versus − 17.4%, p = 0.016; Q1vsQ4 RVEDVi relative bias − 17 versus − 21.9%, p = 0.005). Measurements of cardiac volumes, mass and function by 3DE correlate well with CMR and 3DE accurately detects changes over time. 3DE underestimates volumes and the relative bias increases with larger cardiac size.

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Acknowledgements

The authors would like to thank the many staff members all sites for helping conduct the Pro@Heart study. We would particularly like to thank the clinical research assistants Kristel Janssens, Sofie van Soest, Dorien Vermeulen and Daisy Thijs for their dedication and devoted efforts to include, test, and follow-up participants. On behalf of the Pro@Heart consortium: Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium, Department of Cardiology, University Hospitals Leuven, Leuven, Belgium (Sofie Van Soest), Department of Movement Sciences, KU Leuven, Leuven, Belgium (Peter Hespel), Department of Radiology, University Hospitals Leuven, Leuven, Belgium (Steven Dymarkowski), Department of Radiology, University Hospitals Leuven, Leuven, Belgium (Tom Dresselaers), Department of Cardiovascular Sciences, University of Antwerp, Antwerpen, Belgium, Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium (Hielko Miljoen), Department of Cardiovascular Sciences, University of Antwerp, Antwerpen, Belgium, Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium (Kasper Favere), Department of Cardiovascular Sciences, University of Antwerp, Antwerpen, Belgium, Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium (Dorien Vermeulen), Department of Cardiovascular Sciences, University of Antwerp, Antwerpen, Belgium, Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium (Isabel Witvrouwen), Department of Cardiology, Hartcentrum, Jessa Ziekenhuis, Hasselt, Belgium, Faculty of Medicine and Life Sciences, Cardiology and Organ systems, Hasselt University, Diepenbeek, Belgium (Dominique Hansen), Department of Cardiology, Hartcentrum, Jessa Ziekenhuis, Hasselt, Belgium (Daisy Thijs), Department of Cardiology, Hartcentrum, Jessa Ziekenhuis, Hasselt, Belgium (Peter Vanvoorden), Department of Cardiology, Algemeen Ziekenhuis Nikolaas, Sint-Niklaas, Belgium (Kristof Lefebvre), Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia (Amy Mitchell), Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia (Maria Brosnan), Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia (David Prior), Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia (Adrian Elliott), Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia (Prashanthan Sanders), Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia (Jonathan Kalman), Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia (Diane Fatkin).

Funding

The National Health and Medical Research Council of Australia (APP1130353).

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Authors and Affiliations

  1. Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium

    Ruben De Bosscher, Mathias Claeys, Piet Claus, Rik Willems & Guido Claessen

  2. Department of Cardiology, University Hospitals Leuven, Leuven, Belgium

    Ruben De Bosscher, Mathias Claeys, Kaatje Goetschalckx, Rik Willems & Guido Claessen

  3. Department of Cardiology, Hartcentrum, Jessa Ziekenhuis, Hasselt, Belgium

    Lieven Herbots

  4. REVAL/BIOMED, Hasselt University, Diepenbeek, Belgium

    Lieven Herbots & Olivier Ghekiere

  5. Department of Radiology, Jessa Ziekenhuis, Hasselt, Belgium

    Olivier Ghekiere

  6. Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium

    Caroline Van De Heyning, Bernard P. Paelinck & Hein Heidbuchel

  7. Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium

    Caroline Van De Heyning, Bernard P. Paelinck & Hein Heidbuchel

  8. Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia

    Kristel Janssens, Leah Wright, Michael Darragh Flannery & André La Gerche

  9. Department of Radiology, University Hospitals Leuven, Leuven, Belgium

    Jan Bogaert

  10. Department of Movement Sciences, KU Leuven, Leuven, Belgium

    Christophe Dausin

  11. Department of Cardiovascular Medicine, University Hospitals Leuven, B-3000, Leuven, Belgium

    Ruben De Bosscher

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  1. Ruben De Bosscher
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Consortia

The Pro@Heart consortium

  • Sofie Van Soest
  • , Peter Hespel
  • , Steven Dymarkowski
  • , Tom Dresselaers
  • , Hielko Miljoen
  • , Kasper Favere
  • , Dorien Vermeulen
  • , Isabel Witvrouwen
  • , Dominique Hansen
  • , Daisy Thijs
  • , Peter Vanvoorden
  • , Kristof Lefebvre
  • , Amy Mitchell
  • , Maria Brosnan
  • , David Prior
  • , Adrian Elliott
  • , Prashanthan Sanders
  • , Jonathan Kalman
  •  & Diane Fatkin

Contributions

R.D.B. wrote the manuscript and prepared the figures. All authors reviewed the manuscript.

Corresponding author

Correspondence to Ruben De Bosscher.

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The authors have not disclosed any competing interests.

Disclosures

RDB, MC, CD, KG, PC, LH, OG, CVDH, BP, KJ, LW, MDH, ALG, HH, JB, GC none. RW is supported as postdoctoral clinical researcher by the Fund for Scientific Research Flanders.

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De Bosscher, R., Claeys, M., Dausin, C. et al. Three-dimensional echocardiography of the athlete’s heart: a comparison with cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 39, 295–306 (2023). https://doi.org/10.1007/s10554-022-02726-5

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