Measurement of Left Ventricular Volumes and Ejection Fraction in Patients with Regional Wall Motion Abnormalities Using an Automated 3D Quantification Algorithm

Accurate and rapid left ventricular (LV) ejection fraction (EF) measurement is crucial for patients with wall motion abnormalities (WMAs). Conventional 2D echocardiographic imaging has limitations. The recently developed software HeartModel (HM, Philips Healthcare, Andover, MA, USA) has shown promise in automated 3D quantification. However, the accuracy and detailed features of HM in measurements of LV volume and EF in patients with regional WMAs have not been carefully investigated. In the present study, echocardiographic imaging (EPIQ, X5-1, Philips Healthcare) was performed in 72 patients with WMAs. The LV end-diastolic volume (EDV), end-systolic volume (ESV) and EF were measured by HM in three modes: without editing and with global and regional endocardial border editing (Auto 3D-NE, Auto 3D-GE and Auto 3D-RE, respectively). The conventional 2D Simpson's biplane method and manual 3D quantification (QLAB-3DQA software, Philips Healthcare), as the standard method, were used for comparison. Among the three HM modalities, Auto 3D-RE exhibited the best correlation with manual 3D in assessing EDV, ESV and EF (r = 0.88, 0.93 and 0.91, respectively), although it took slightly longer (67.3 ± 13.0 s). Auto 3D-RE also exhibited a small degree of bias for the measurements (EDV: 11.7mL, ESV: 8.45mL, EF: -1.57%) and narrow limits of agreement. Heterogeneity of LV wall motion was defined to indicate the dispersion degree of WMAs. It associated with the difference in EF measurement between Auto 3D-RE and manual 3D (p = 0.014, hazard ratio = 5.19). In patients with WMAs, HM with regional contour editing enables accurate and efficient evaluation of LV volume and EF.