Three-Dimensional Echocardiography is a Feasible and Reproducible Method for the Measurement of Left Atrial Volumes, Regardless of Expertise Level

Left atrium (LA) assessment has gained significant interest in recent years because of its diagnostic and prognostic role in cardiovascular diseases. We aimed to assess the feasibility and reproducibility of three-dimensional echocardiography (3DE) versus two-dimensional echocardiography (2DE) for LA volumes (LAV) when measurements were performed by users with different levels of expertise in 3DE. We prospectively recruited 35 consecutive patients referred to our echocardiography laboratory. Subjects underwent two separate 2DE and 3DE acquisitions of the LA in the same day by different users. Left atrial volumes were measured by the two users, who had similar levels of training in 2DE but different levels of training in 3DE - one advanced user and one beginner user. Our results showed a good intra-observer reproducibility for 2DE (r=0.98) and an equally good reproducibility for 3DE LAVs when measured by the beginner user (r=0.97). Similarly, there was a good inter-observer reproducibility for the 2DE LAVs when measured by observers with similar levels of expertise in 2DE (r=0.98). However, similarly reproducible results were obtained for the 3DE LAVs when measured by users with significantly different levels of training in 3DE (r=0.98). Furthermore, there was a lower, yet acceptable (r>0.8), reproducibility for the 2DE LAVs when measured on separately acquired datasets by users who acquired the respective datasets, both with advanced level of training in 2DE. However, reproducibility was superior for 3DE LAVs when measured by the beginner and advanced users in 3DE (r=0.97). We conclude that 3DE is a technique that promises to improve patients' overall assessment, showing a good feasibility and better reproducibility than 2DE for the measurement of LAVs, regardless of level of training in the method.