Quantification of left ventricular volumes and function in anesthetized beagles using real-time three-dimensional echocardiography: 4D-TomTec™ analysis versus 4D-AutLVQ™ analysis in comparison with cardiac magnetic resonance imaging

BACKROUND Real-time three-dimensional echocardiography (RT3DE) enables accurate volume determination of the left ventricle (LV), since measurements in foreshortened depicted views are avertable. Different analyzing programs are available for this RT3DE. The commonly used semi-automatic software 4D-AutLVQ™ showed underestimation of LV volumes in comparison with CMRI in healthy anesthetized dogs (Am J Vet Res 74(9):1223-1230, 2013). TomTec 4D LV-Function™ is an offline analysis program for morphological and functional analyses of the left ventricle by using manual measurement optimization, showing excellent agreement with CMRI in human medicine (Echocardiography 27(10):1263-1273, 2010; Eur J Echocardiogr 11(4):359-368, 2010; Echocardiography 24(9):967-974, 2007). The aim of the present study was to compare these different RT3DE analyzing software programs to test the possibility of one performing better than the other by assessing accuracy and reproducibility in comparison with the reference method cardiac magnetic resonance imaging (CMRI) by determining the left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF). RT3DE and CMRI were performed during anesthesia in 10 healthy beagles. The analyzing programs 4D-AutLVQ™ (based on semi-automated border detection) and TomTec 4D LV-Function™ (primary manual tracking with semi-automated border detection) were used for RT3DE volume analysis of the left ventricle. Left ventricular EDV, ESV, SV and EF were measured and compared to those measured by the reference method CMRI. Repeated measurements were performed to determine inter- and intra-observer variability. RESULTS Both, 4D-AutLVQ™ and 4D-TomTec™ showed small but significant underestimation for EDV and ESV with quite good correlation (r = 0.34-0.69) in comparison with CMRI, without significant difference between each of them. Ejection fraction (EF) measured by 4D-TomTec™ showed no significant differences compared to CMRI (p = 0.12), while 4D-AutLVQ™ significantly underestimated LV-EF (p = 0.03). Analyzing time was shorter using 4D-AutLVQ™ compared to 4D-TomTec™. The inter-observer variability was higher using 4D-TomTec™ than with 4D-AutLVQ™, whereas both methods present excellent intra-observer variability. CONCLUSION 4D-TomTec™ and 4D-AutLVQ™ are feasible RT3DE analyzing programs, allowing accurate volume quantification of the left ventricle, albeit with significant underestimation of ventricular volumes in comparison with the gold standard CMRI. 4D-AutLVQ™ is performed faster with less inter-observer variability than 4D-TomTec™. Therefore, 4D-AutLVQ™ is the more practicable measurement method when comparing the different analyzing programs.