Objectives .– Three-dimensional echocardiography (3DE) led to significant improvement in the accuracy and reproducibility of left ventricular volumes (LVV) and ejection fraction (EF) measurements but remains sensitive to patient echogenicity. The aim of this study was to evaluate the impact of temporal resolution, spatial resolution and image dynamic range on the ability of 3-dimensional contrast-enhanced echocardiography (C3DE) to assess LV function compared to CMR.

Patients and methods .– We investigated 54 consecutive patients referred to our institution who underwent LV function assessment using both contrast echocardiography and cardiac magnetic resonance imaging CMR. All patients underwent two-dimensional echocardiography (2DE), non-contrast 3-dimensional echocardiography (NC3DE) and contrast-enhanced (C3DE) and CMR. LVV and EF were calculated for all modalities.

Results .– Left ventricular end-diastolic volume (EDV) was underestimated by 2DE (141.8 ± 58.3 mL), 3DE (145.6 ± 68.6 mL), and to a lesser extent by C3DE (172.3 ± 72 mL) compared to CMR (216.1 ± 85.0 mL, all P values < 0.001). Results were similar for calculation of LVESV. C3DE provided the best agreement with CMR with a greater Lin’s concordance correlation coefficient of 0.67, 0.93 and 0.99 respectively for EDV, ESV and LVEF and less drift of the bias for LVV and EF (lowest r ² coefficient values between the difference and the average of the measurement, respectively r ² = 0.14, 0.18 and 0.01 for EDV, ESV and EF) as well as the best measurement reproducibility. Finally, ultrasound settings (spatial and temporal resolution, dynamic range) had no significant effect on volumes and ejection fraction measurements according to MRI.

Conclusion .– C3DE overcomes 2DE and NC3DE and is a powerful alternative to CMR in patients with poor ultrasound image quality. Furthermore, this study showed that the choice of ultrasound settings, despite a sharp deterioration in spatial and temporal resolution, did not alter the accuracy of LV function assessment.