Quantification of left ventricular volumes by two-dimensional echocardiography: a simplified and accurate approach.

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Abstract
A new and simplified method to determine left ventricular (LV) volumes with two-dimensional echocardiography (2-D echo) was developed which used the parasternal long-axis and apical 4- and 2-chamber views. An end-diastolic area (EDA) was derived from the longest minor axis (Dmax) from either of the 3 views and the major long axis (Lmax) from the apical views, with the formula EDA = Dmax .cntdot. Lmax .cntdot. .pi./4. LV end-diastolic volumes (EDV) obtained by single-plane angiograms were correlated with the EDA derived from 2-D echo in 25 initial patients, and the resultant equation, EDV = (EDA .times. 4.35) - 6.44 (r = 0.82, SEE [standard error of the estimate] = 34 ml), was applied prospectively to 27 patients (r = 0.95, SEE = 19 ml) and to the 52 combined patients without underestimation according to the equation y = 1.07 .times. - 7.3. Of the 52, 29 patients had coronary artery disease and regional dyssynergy. Ejection fraction (EF), measured with a previously validated method that uses the average of several LV dimensions, correlated well with angiographic EF in the initial (r = 0.96, SEE = 5%) and prospective (r = 0.87, SEE = 8%) series and in both series combined (r = 0.92, SEE = 7%). End-systolic volume (ESV) was derived by substracting stroke volume (EDV .times. EF) from EDV. Correlation coefficients for 2-D echo ESV vs. angiographic ESV were 0.91, 0.97 and 0.94, with SEE of 25, 12 and 19 ml for the initial, prospective and combined series, respectively. Two-dimensional echo EDV, EF and ESV also correlated well (r = 0.89-0.97) with biplane angiographic results in 15 of 27 prospective patients. Comparisons between 2 independent observers revealed high r values (0.958-0.965) and mean differences for EDV, EF and ESV of .+-. 3, .+-. 6 and .+-. 8%, respectively. Thus, a simplified method of determining LV volumes with 2-D echo without a need for planimetry or computer assistance was validated.

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