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In vitro quantitation of canine left ventricular volume by phased-array sector scan.

Ultrasonic sector-scan images can delineate the entire circumference of the canine left ventricle in vitro. This study was undertaken to (1) assess the accuracy of sector scanning for estimating canine left ventricular volume in vitro compared to volume estimates by M-mode echo in the same hearts and (2) determine the optimal techniques for estimating left ventricular volume with sector scanning. 16 volumes (1 volume from 8 hearts and 2 volumes from 4 hearts) were estimated by obtaining sector-scan images from orthogonal long-axis, short-axis and apical views. The sector-scan volumes were calculated by single and biplane area-length methods, as well as biplane Simpson's rule methods, and compared to measured left ventricular volumes. M-mode echo volumes were calculated by cubing the mid-ventricular minor-axis diameter. Sector-scan views containing a long-axis dimension plus the short-axis dimension of the left ventricle had a high correlation with true left ventricular volume while sector-scan views not containing a long-axis view showed only a fair correlation with volume. M-mode echo produced a poor estimate of the true left ventricular volume. It is concluded that (1) sector scanning can provide highly accurate in vitro volume estimates of canine left ventricles which is superior to estimates derived by M-mode echocardiographic methods and (2) the optimal sector-scan views for estimating left ventricular volume are those that make the fewest assumptions about left ventricular geometry and have the greatest amount of dimensional information.

Animals↗

[Right ventricular volume determination by two-dimensional echocardiography and radiography in model hearts using a subtraction method].

The irregularity and complexity of the right ventricle is the reason why no accurate method for right ventricular volume determination exists. A new method for right ventricular volume determination particularly for two-dimensional echocardiography was developed-it is called subtraction method-and was compared with the pyramid and Simpson's methods. The partial volume of the left ventricle and septum was subtracted from total volume of right and left ventricle including interventricular septum. Thus right ventricular volume resulted. Total and partial volume were computer-assisted calculated by use of biplane methods, preferably Simpson's rule. The method was proved with thinwall silicon-rubber model hearts of the left and right ventricle. Two orthogonal planes in the long-axis were filmed by radiography or scanned in a water bath by two-dimensional echocardiography equivalent to RAO and LAO-projections of cineangiocardiograms or to four- and two-chamber views of apical two-dimensional echocardiograms. For calculation of the major axes of the elliptical sections, summed up by Simpson's rule, they were derived from the LAO-projection and the four-chamber view, respectively, the minor axis approximated from the RAO-projection and the two-chamber view. For comparison of direct-measured volume and two-dimensional echocardiographically determined volume, regression equation was given by y = 1.01 x -3.2, correlation-coefficient, r = 0.977, and standard error of estimate (SEE) +/- 10.5 ml. For radiography, regression equation was y = 0.909 x + 13.3,r = 0.983, SEE = +/- 8.0 ml. For pyramid method and Simpson's rule, higher standard errors and lower correlation coefficients were found. Between radiography and two-dimensional echocardiography a mean difference of 4.3 +/- 13.2 ml, using subtraction method, and -10.2 +/- 22.9 ml, using pyramid method, as well as -0,6 +/- 18.5 ml, using Simpson's rule, were calculated for right ventricular volume measurements. Differences were not significant. The subtraction method seems to be useful for calculation of right ventricular volume by radiography as well as two-dimensional echocardiography. Further studies in isolated hearts and patients are necessary for final judgment of the accuracy of this new method.

Blood Volume↗

Measurement of right ventricular volume in healthy term and preterm neonates.

BACKGROUND: Pulmonary hypertension is associated with worse perinatal outcomes in infants with respiratory disorders. In such infants right ventricular dysfunction may result in poor pulmonary blood flow. OBJECTIVE: To evaluate the practicability and repeatability of echocardiographic measurements of right ventricular volume in healthy term and preterm neonates, and to follow changes in right ventricular volume over the first 2 days of life. METHODS: Serial echocardiographic examinations were performed on day 0, 1, and 2 on healthy term and preterm neonates. Two methods of estimating right ventricular volume were assessed: the ellipsoid approximation and Simpson's stacked discs methods. Systolic and diastolic volumes on days 1 and 2 were compared with baseline values on day 0. Term and preterm volumes were compared at the same time points. RESULTS: Thirty five infants were recruited, 18 term and 17 preterm. Right ventricular volumes were significantly lower on day 1 and day 2 than baseline in both term and preterm infants. Median (interquartile range) end systolic and diastolic volumes for term infants on days 0, 1, and 2 were 1.04 (0.88-1.44), 0.82 (0.70-1.03), 0.92 (0.72-0.97) ml/kg and 2.21 (2.10-2.75), 2.05 (1.81-2.38), 1.91 (1.81-2.13) ml/kg respectively. In preterm infants the values were 1.09 (0.91-1.16), 0.72 (0.54-0.91), 0.61 (0.54-0.76) ml/kg and 2.09 (1.71-2.25), 1.47 (1.23-1.98), 1.43 (1.22-1.78) ml/kg respectively. CONCLUSION: Right ventricular volume decreases over the first 2 days of life in healthy term and preterm infants.

Cardiac Output↗

Rapid computed tomography technique to measure ventricular volumes in the child with suspected ventriculoperitoneal shunt failure II. Clinical application.

OBJECTIVES: Assessment of ventricular volume change is critical in the child with suspected shunt failure. Minimal increases may represent high pressures in the child with reduced ventricular compliance but are difficult to detect subjectively. Objective techniques described limit anatomic sampling and are time intensive. The purpose of this study was to develop a rapid technique to measure ventricular volumes in children with suspected shunt failure. METHODS: Ventricular volumes were calculated in 12 children with baseline and emergent computed tomography scans performed for suspected shunt failure. Volumes and percent interval changes were correlated with clinical course. Two observers performed the volume analysis blinded to the clinical information; 1 observer performed the analysis twice. Time to perform the analysis was recorded for 5 studies. RESULTS: The intraobserver and interobserver correlation coefficients were 0.99 and 0.96/0.97, respectively. The mean time to perform the analysis was 2 minutes 42 seconds. Median percent change in patients with and without shunt obstruction was +50% (range: +24%-+367%) and +2% (range: -22%-+36%), respectively. Among patients subjectively read as having stable ventricular sizes, volume changes of -11% to +32% were calculated. CONCLUSIONS: The technique has excellent intra- and interobserver correlation and is rapidly performed. The range of percent volume changes between patients with and without shunt malfunction overlaps. Subjective assessment of ventricular changes is significantly less sensitive than the volume calculation technique. The technique may be most useful in patients with decreased ventricular compliance in whom small interval changes may represent large pressure increases.

Adolescent↗

[Measurement of left atrial and ventricular volumes in real-time 3D echocardiography. Validation by nuclear magnetic resonance].

The measurement of the left ventricular ejection fraction is important for the evaluation of cardiomyopathy and depends on the measurement of left ventricular volumes. There are no existing conventional echocardiographic means of measuring the true left atrial and ventricular volumes without mathematical approximations. The aim of this study was to test anew real time 3-dimensional echocardiographic system of calculating left atrial and ventricular volumes in 40 patients after in vitro validation. The volumes of the left atrium and ventricle acquired from real time 3-D echocardiography in the apical view, were calculated in 7 sections parallel to the surface of the probe and compared with atrial (10 patients) and ventricular (30 patients) volumes calculated by nuclear magnetic resonance with the simpson method and with volumes of water in balloons placed in a cistern. Linear regression analysis showed an excellent correlation between the real volume of water in the balloons and volumes given in real time 3-dimensional echocardiography (y = 0.94x + 5.5, r = 0.99, p < 0.001, D = -10 +/- 4.5 ml). A good correlation was observed between real time 3-dimensional echocardiography and nuclear magnetic resonance for the measurement of left atrial and ventricular volumes (y = 0.95x - 10, r = 0.91, p < 0.001, D = -14.8 +/- 19.5 ml and y = 0.87x + 10, r = 0.98, P < 0.001, D = -8.3 +/- 18.7 ml, respectively. The authors conclude that real time three-dimensional echocardiography allows accurate measurement of left heart volumes underlying the clinical potential of this new 3-D method.

Aged↗

The repeatability of left ventricular volume assessment by a new ambulatory radionuclide monitoring system during head-up tilt.

The precise measurement of changes in left ventricular volume is important to elucidate the mechanisms of neurally mediated syncope. This study was conducted to determine whether or not a brand-new ambulatory radionuclide monitoring system (C-VEST system) can be clinically used to easily and precisely measure left ventricular volume and function in tilt testing. To assess the repeatability of the C-VEST system, 12 healthy volunteers (mean age 24+/-4 years old) underwent 20 minute head-up tilt testing and we measured the temporal changes in left ventricular volume and ejection fraction twice a day (first and second studies). To investigate the changes in the C-VEST measurements and the detector position in the first and second studies, tilt testing was performed with an 80-degree passive tilt, which is the same as the standard procedure used in diagnosing neurally mediated syncope. The coefficient of repeatability for both the C-VEST and detector position was well within the clinical range (coefficient of repeatability in left ventricular volume ranged from 1.7 to 2.8; coefficient of repeatability in the detector position ranged from 2.3 to 3.1). Precise evaluation of the left ventricular volume can be achieved by an ambulatory radionuclide monitoring system in tilt testing.

Adult↗

Three-dimensional echocardiography: in-vitro validation of a new, voxel-based method for rapid quantification of ventricular volume in normal and aneurysmal left ventricles.

BACKGROUND: Previous approaches to ventricular volume calculations by 3-dimensional echocardiography (3-DE) required multiple transverse tomographic sectioning and summation of the volumes of parallel disks. These methods were time consuming and beared the risk of missing the apical volume. METHODS: We investigated the accuracy of a new, rapid method of 3-DE volume measurements in normal (LV) and aneurysmal (aneurLV) left ventricles in fixed pig hearts. 3-D data sets of 12 LV and 8 experimentally created aneurLV were obtained using a TomTec 3-DE system. For 3-DE volume calculations, a rotational axis in the center of the left ventricle (apical-basal orientation) was defined and 3, 6 and 12 equi-angular rotational planes were created. In each plane the endocardial border was traced and the volume of the corresponding wedge was automatically calculated. The measurements were performed by 2 independent investigators blinded to the anatomic volume and were analyzed for inter- and intraobserver variability. RESULTS: The anatomic volumes ranged from 5 to 150 ml and 9 to 40 ml in LV and aneurLV, respectively. The correlation between 3-DE and anatomic volume was excellent for LV and aneurLV traced in 3, 6 and 12 planes (r = 0.94-0.99). Ventricular volume was well predicted by 3-DE reconstruction: SEE 5.5-7.1 ml (LV), 3.0-3.2 ml (aneurLV). The correlation for interobserver measurements was good in both, LV (r = 0.99) and aneurLV (r = 0.94-0.99) even in 3 planes. The intra- and interobserver variabilities were 1.6-3.0 ml (<7%) and 7.2-7.3 ml (<15%) in LV and 1.1-1.6 (<6%) and 2.1-3.3 ml (<14%) in aneurLV respectively. CONCLUSION: This new 3-DE method of ventricular volume measurements using a rotational approach provides rapid, accurate and reproducible volume measurements in LV and aneurLV.

Animals↗

Ventricular volume in man computed from CAT scans.

A new interactive computers has been developed to measure ventricular volume from CAT scans. Testing this system on phantoms demonstrated an accuracy to within 16%. Then a series of scans of patients with obstructive hydrocephalus was analyzed using both tradional linear measures and the computer method. None of the traditional measures were directly proportional to the calculated volume. The area measure of ventricular volume correlated well with the computer-generated values. Clinical studies which attempt to quantitate ventricular volume should use a computerized or planigraphic measure.

Cerebral Ventricles↗

Relationship between instantaneous trans-mitral blood flow velocity and instantaneous left ventricular volume in normal and hypertrophied hearts.

We examined the relationship between trans-mitral blood flow velocity and left ventricular volume in normal and hypertrophied hearts using cross-sectional Doppler echocardiography. We studied 10 normal subjects and 19 patients with left ventricular hypertrophy, 9 with aortic stenosis and 10 with dilated cardiomyopathy. Trans-mitral Doppler flow velocity signals and cross-sectional echocardiograms of the left ventricular short and long axes were digitized in each patient to obtain instantaneous mitral flow velocity, instantaneous left ventricular volume, left ventricular mass, and left ventricular mass/volume ratio at end-diastole. Peak velocities during rapid filling (E wave) were similar in all three groups. Peak velocities during atrial systole (A wave) were significantly increased in aortic stenosis, (124 +/- 28 cm/sec); but were not different from normal in dilated cardiomyopathy (43 +/- 20 cm/sec versus 32 +/- 9 cm/sec). The peak A/E velocity ratio was elevated in aortic stenosis 1.47 +/- 0.30, but in dilated cardiomyopathy it was similar to normal hearts (0.47 +/- 0.23 versus 0.54 +/- 0.15). The percentages of left ventricular filling achieved at the time of the peak E wave, the end of rapid filling, and at the time of the peak A wave were similar in all three patient groups. There was no correlation between blood flow velocities at peak E wave, peak A wave or the A/E velocity ratio and left ventricular volume or mass. There was a significant correlation between peak A velocities and left ventricular muscle/cavity areas (r = 0.81; P less than 0.001). There was a similarly close correlation between the peak A/E velocity ratios and left ventricular muscle/cavity areas (r = 0.80; P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Postextrasystolic potentiation during spontaneous ventricular ectopy in man. Associated left ventricular volume changes determined by list mode radionuclide ventriculography.

Five patients with spontaneously arising frequent ventricular ectopia were studied by list mode radionuclide ventriculography. Changes in left ventricular volumes reflected the increased inotropy of the postextrasystolic sinus beats: stroke volume increased by +36.0 +/- 32.8% (P less than 0.05) and end-systolic volumes decreasing by 13.6 +/- 7.3% (P less than 0.02) leading to an increased ejection fraction (+31.1 +/- 23.8%; P less than 0.05). There were no significant increases in end-diastolic volumes (+2.2 +/- 5.4%; P:NS). The reproducibility of the left ventricular volume estimates was confirmed by comparing the control sinus beats with the interrupted sinus beats. There were no significant changes in end-diastolic (+1.8 +/- 5.5%), end-systolic (+1.8 +/- 3.7%) and stroke volumes (+5.4 +/- 14.6%). List mode radionuclide ventriculography can be used to accurately monitor left ventricular volume changes associated with spontaneously arising ventricular ectopia. In these patients, the contribution of Frank-Starling mechanism to postextrasystolic potentiation was minimal.

Adult↗

Two-dimensional echocardiographic determination of ventricular volumes in the fetal heart. Validation studies in fetal lambs.

The determination of ventricular volumes in the fetal heart from two-dimensional echocardiography (2DE) may give a better estimate of fetal ventricular size than simple diameter measurements, but the accuracy of this method has not been established. In fetal lambs, we tested whether ventricular volume calculations from 2DE using a biplane Simpson's rule algorithm are accurate. Calculations of left and right ventricular end-diastolic volumes from 2DE were compared with cast volumes of these ventricles. Also, at different levels of left atrial pressure, left ventricular stroke volumes calculated from 2DE were compared with stroke volumes measured simultaneously by an electromagnetic flowmeter. There was a good correlation between volumes determined from 2DE (y axis) and from casts (x axis) for both the left (r = 0.92; y = 0.2 + 1.1x; SEE = 0.19 ml) and right ventricle (r = 0.90; y = 0.7 + 0.9x; SEE = 0.21 ml). Left ventricular stroke volumes calculated from 2DE correlated well with those measured by the electromagnetic flowmeter (r = 0.87; y = 0.2 + 0.9x; SEE = 0.27 ml). Thus, calculation of fetal ventricular volumes from 2DE images using a biplane Simpson's rule method is feasible and accurate.

Animals↗

Accuracy of radionuclide ventriculography for estimation of left ventricular volume changes and end-systolic pressure-volume relations.

Estimation of left ventricular end-systolic pressure-volume relations depends on the accurate measurement of small changes in ventricular volume. To study the accuracy of radionuclide ventriculography, paired radionuclide and contrast ventriculograms were obtained in seven dogs during a control period and when blood pressure was increased in increments of 30 mm Hg by phenylephrine infusion. The heart rate was held constant by atropine infusion. The correlation between radionuclide and contrast ventriculography was excellent. In the individual animals, the average r value for left ventricular volume was 0.96 +/- 0.03 (+/- SD) (p = 0.001, n = 7) and the mean r value for end-systolic volume changes was 0.90 +/- 0.08 (n = 7, range 0.76 to 0.99). For the entire series, there were 33 end-systolic volume changes, and there was an equally strong radionuclide-contrast correlation (r = 0.89, p less than 0.001, n = 33), even though the volume changes averaged only 11.9 +/- 8.2 ml (range 0.3 to 38.1). The systolic pressure-volume relations were linear for both radionuclide and contrast ventriculography (r = 0.98 and 0.97, respectively, n = 7). The mean slope for radionuclide ventriculography (2.9 +/- 1.4) was lower than the mean slope for contrast ventriculography (4.8 +/- 1.7) (p = 0.004); however, the slopes correlated well (r = 0.81, n = 7, p = 0.026). The radionuclide-contrast volume relation was compared using background subtraction, attenuation correction, neither of these or both. By each method, radionuclide ventriculography was valid for measuring small changes in left ventricular volume and for defining end-systolic pressure-volume relations.

Animals↗

Determination of left ventricular volumes with use of a new nongeometric echocardiographic method: clinical validation and potential application.

A new nongeometric echocardiographic technique for measurement of right and left ventricular volumes was recently validated in vitro. With this method, all images are taken from one point on the chest wall as the transducer is tilted through the ventricle. This approach offers several advantages. No geometric assumptions about ventricular shape are made. All images are acquired from the best echocardiographic window. Furthermore, the digitized points can be used to make a three-dimensional reconstruction of the ventricle. The present study addresses the clinical feasibility of imaging the heart from a single pivoting point in short axis and compares the accuracy of the method in determining left ventricular volumes with that of biplane cineangiography. Twenty-four patients underwent echocardiographic studies within 2 h before angiography. At catheterization, volumes determined by the biplane area-length method ranged between 95 and 368 ml at end-diastole and between 15 and 303 ml at end-systole. A good correlation was observed between ventricular volumes by angiography and echocardiography at end-diastole and end-systole (r = 0.92 and 0.96, respectively). Correlations between volumes by the two techniques were equally good in patients with wall motion abnormalities (n = 13; r = 0.97). Ventricular ejection fraction ranged between 18% and 84% at angiography and correlated well with echocardiographic measurements (r = 0.82). Thus, the echocardiographic tilt method provides accurate determination of left ventricular volume and ejection fraction. This nongeometric method offers the potential for the determination of right ventricular volume and three-dimensional display of the heart.

Adult↗

Intracardiac ultrasound determination of left ventricular volumes: in vitro and in vivo validation.

OBJECTIVES: This study was designed to assess the feasibility of calculating left ventricular volumes using intracardiac ultrasound. BACKGROUND: Previous studies have validated transthoracic echocardiographic determinations of left ventricular volumes and have indicated the superiority of Simpson rule reconstruction algorithms. The feasibility of imaging the left ventricle with intracardiac ultrasound has also been demonstrated. METHODS: The determination of left ventricular volumes with Simpson rule reconstruction of intracardiac ultrasound images was evaluated in two phases. In vitro validation was performed in 29 animal hearts preserved in either a nondistended or distended state. Latex cast volumes were the reference standard. In vivo studies used 14 pigs, and compared intracardiac ultrasound volumes and ejection fraction with single-plane contrast angiographic values. A 12.5-MHz device was used to record short-axis images at 0.5-cm intervals. These were used to reconstruct the ventricle as a stack of cylindric elements using all imaged levels as well as sections recorded every 1 and 2 cm and at a single midventricular level. RESULTS: In the in vitro hearts, when all recorded sections were used, there was excellent agreement between intracardiac ultrasound and latex cast volumes (intracardiac ultrasound volume = 0.89 latex cast volume + 2.22, r = 0.95; intracardiac ultrasound volume = 0.97 latex cast volume + 0.91, r = 0.99) for nondistended and distended hearts, respectively. In vivo, there was again close correspondence between ultrasound and angiographic volumes (intracardiac ultrasound volume = 1.04 angiographic volume - 3.6, r = 0.91). The relation between intracardiac ultrasound and angiographic ejection fraction was fair (intracardiac ultrasound ejection fraction = 1.00 angiographic ejection fraction + 6.85, r = 0.69). Excellent correlations for the volumes were maintained as the number of cross sections was reduced to those recorded every 1 and 2 cm (r = 0.87 to 0.99). With a single midventricular site more variable but generally good correlations were obtained (r = 0.77 to 0.99). CONCLUSIONS: The application of Simpson rule reconstruction to short-axis images of the left ventricle obtained with intracardiac ultrasound provides accurate determination of left ventricular volumes in animal hearts. This technique may prove useful in the analysis of left ventricular structure and function.

Algorithms↗

Nomogram for calculation of left ventricular volumes.

A nomogram has been devised for the rapid derivation of left ventricular volumes from single-plane angiograms obtained in the 30 degrees right anterior oblique projection. The left ventricular volumes are derived from the use of the area-length formula of Dodge. The computed left ventricular volumes may then be adjusted to correspond to the actual volumes by an appropriate conversion chart.

Cardiac Volume↗

Three-dimensional echocardiography: the influence of number of component images on accuracy of left ventricular volume quantitation.

One approach to three-dimensional echocardiography is to reconstruct the surface of cardiac structures from two-dimensional images positioned in three-dimensional space. This approach has yielded accurate measures; however, the relationship between the number of nonparallel images used in three-dimensional echocardiographic reconstruction to the accuracy of the volume calculated has not been determined. With a canine model in which instantaneous left ventricular volume could be measured in vivo, images were obtained from intersecting long- and short-axis scans and stored with their spatial coordinates. The left ventricle was reconstructed and its volume calculated. The difference between three-dimensional echocardiographic and true volume was determined in 84 different cavitary volumes (4 to 85 ml). In each case, long- and short-axis images were deleted serially from the original data set (maximum of 27) until there were only three images left in the reconstruction. After each set of deletions, left ventricular volume was recalculated with the remaining images. Three-dimensional echocardiography accurately quantified ventricular volume with eight to 12 intersecting images, with a mean error of less than 1 ml and an SD of 5 ml. With a reduction of component images below eight, there were progressive increases in both absolute and mean percentage error. Accurate assessment of stroke volume and ejection fraction in this beating heart model also required eight to 12 images. Left ventricular volume and systolic function can be quantitated by three-dimensional echocardiography with as few as eight to 12 intersecting or nonparallel images.

Analysis of Variance↗

Validation of real-time three-dimensional echocardiography for quantifying left ventricular volumes in the presence of a left ventricular aneurysm: in vitro and in vivo studies.

OBJECTIVES: To validate the accuracy of real-time three-dimensional echocardiography (RT3DE) for quantifying aneurysmal left ventricular (LV) volumes. BACKGROUND: Conventional two-dimensional echocardiography (2DE) has limitations when applied for quantification of LV volumes in patients with LV aneurysms. METHODS: Seven aneurysmal balloons, 15 sheep (5 with chronic LV aneurysms and 10 without LV aneurysms) during 60 different hemodynamic conditions and 29 patients (13 with chronic LV aneurysms and 16 with normal LV) underwent RT3DE and 2DE. Electromagnetic flow meters and magnetic resonance imaging (MRI) served as reference standards in the animals and in the patients, respectively. Rotated apical six-plane method with multiplanar Simpson's rule and apical biplane Simpson's rule were used to determine LV volumes by RT3DE and 2DE, respectively. RESULTS: Both RT3DE and 2DE correlated well with actual volumes for aneurysmal balloons. However, a significantly smaller mean difference (MD) was found between RT3DE and actual volumes (-7 ml for RT3DE vs. 22 ml for 2DE, p = 0.0002). Excellent correlation and agreement between RT3DE and electromagnetic flow meters for LV stroke volumes for animals with aneurysms were observed, while 2DE showed lesser correlation and agreement (r = 0.97, MD = -1.0 ml vs. r = 0.76, MD = 4.4 ml). In patients with LV aneurysms, better correlation and agreement between RT3DE and MRI for LV volumes were obtained (r = 0.99, MD = -28 ml) than between 2DE and MRI (r = 0.91, MD = -49 ml). CONCLUSIONS: For geometrically asymmetric LVs associated with ventricular aneurysms, RT3DE can accurately quantify LV volumes.

Animals↗

Two-dimensional echocardiographic measurements of left ventricular volume and stroke volume of endurance-trained athletes and untrained subjects.

The left ventricular volume (EDV), the left ventricular total volume (TDV), and the stroke volume (SV) of 40 male untrained subjects and 68 endurance athletes were determined using one-dimensional echocardiography, two-dimensional echocardiography, and a combined method. The accuracy of the volume and stroke volume measurements was checked by comparing them to ergometrically determined maximum oxygen pulse (max O2-P) and to radiographic heart volume (HV). There was clear improvement in the EDV, TDV, and SV measurements when using two-dimensional echocardiography and the combined method in comparison to one-dimensional echocardiography. The best correlation to the max-O2-P was reached by TDV2 (combined method, r = 0.8738). This method includes the myocardium of the left ventricle similar to heart volume measurements. The relationship is as close as between HV and max O2-P (r = 0.8665). The method suggested here is sufficiently accurate to be used in performance diagnosis to determine the size of the left ventricular volume and to classify pathological size changes or those due to training.

Adolescent↗