Single-plane and biplane echocardiography: Use of targeted scan planes improves the estimates of left ventricular volume and shape for analysis of postinfarction remodeling

Objective: Acute myocardial infarction and subsequent left ventricular (LV) remodeling induce complex geometric changes quantifiable by 3-dimensional (3D) echocardiography. Our objective was to determine accurate 2-dimensional echocardiographic techniques for analysis of diastolic and systolic LV volume and shape in remodeled hearts. Methods: We obtained 3D apical scans from 16 patients at the acute stage, and at 1 and 6 months after acute myocardial infarction. LV volumes were calculated by 7 methods: (1) Teichholz; (2) Teichholz including the infarcted area; (3) single-plane area-length (AL) using a 2-chamber (2CH) view; (4) single-plane AL using a 4-chamber (4CH) view; (5) single-plane AL using a view including the infarcted area; (6) biplane AL using 2CH and 4CH views; and (7) biplane AL using a view including the infarction region and corresponding orthogonal view (method ALBMIO). LV shape was assessed by 5 methods: (1) a 2CH view; (2) a 4CH view; (3) a single-plane view including the infarcted area; (4) biplane (2CH and 4CH) views; and (5) biplane views including the infarction region and corresponding orthogonal view (method BMIO). Results: For end-diastolic and end-systolic LV volume assessments, all 7 methods correlated with the 3D reference, but method ALBMIO performed best (end-diastolic: r = 0.931, bias = 17.4 mL; endsystolic: r = 0.946, bias = 11.2 mL). For LV shape assessments, method BMIO showed the smallest difference from the 3D reference. Conclusions: With 2-dimensional echocardiographic techniques, quantitative analysis of LV volume and shape is most accurate when a component scan plane is targeted through the infarcted myocardial region.