Author + information
- Received March 12, 1984
- Revision received May 29, 1984
- Accepted June 12, 1984
- Published online December 1, 1984.
- Jean-Luc Vandenbossche, MD1,2,
- Barry L. Kramer, MD1,
- Barry M. Massie, MD, FACC1,
- D. Lynn Morris, MD1 and
- Joel S. Karliner, MD, FACC*,1
- ↵*Address for reprints: Joel S. Karliner, MD, Chief, Cardiology Section (111C), Veterans Administration Medical Center, 4150 Clement Street, San Francisco, California 94121.
To evaluate the usefulness of two-dimensional echocardiography in asymptomatic or minimally symptomatic patients with significant aortic regurgitation and left ventricular enlargement, left ventricular size and function measurements obtained by a nongeometric technique, gated blood pool radionuclide angiography, were compared with measurements made by several two-dimensional echocardiographic methods in 20 patients.
Left ventricular size was best assessed by an apical biplane modified Simpson's rule algorithm obtained by computer-assisted planimetry. For end-diastolic volume, r = 0.95 and standard error of the estimate = 25 ml; for end-systolic volume, r = 0.94 and standard error of the estimate = 16 ml. A newly introduced simplified two-dimensional method obviating the need for planimetry and using multiple axis measurements yielded satisfactory results, although volumes larger than 300 ml were markedly underestimated. Evaluation of volumes from a single minor axis measured directly from two-dimensional images and M-mode tracings obtained under two-dimensional echocardiographic control was inadequate for clinical use.
Ejection fraction was correctly assessed by the modified Simpson's rule method as well as by the simplified two-dimensional method (r = 0.81 to 0.83, standard error of the estimate = 7%). However, when methods without planimetry were further simplified, a satisfactory correlation was no longer obtained. The M-mode approach using a corrected cube formula also provided an accurate estimation of ejection fraction, a finding that is attributed to the absence of regional wall motion abnormalities in this group of patients, the ability to locate the M-mode beam more adequately under two-dimensional control arid the persistence of an ellipsoidal configuration and a circular cross section in the left ventricular chamber.
The data indicate that two-dimensional echocardiography is a valuable approach to the assessment of left ventricular size and function in these patients. Moreover, this approach provides a practical and convenient way of improving M-mode evaluation of function and of determining left ventricular shape, thus permitting adequate selection of geometric algorithms for volume calculations.
with the technical assistance of Christine Anderson, Debra Loge
- Received March 12, 1984.
- Revision received May 29, 1984.
- Accepted June 12, 1984.
- American College of Cardiology Foundation