TYPE Original Research PUBLISHED 22 December 2022 DOI 10.3389/fcvm.2022.1065131 OPEN ACCESS EDITED BY Giuseppe Pannarale, Sapienza University of Rome, Italy REVIEWED BY Ferdinando Loiacono, Humanitas Research Hospital, Italy Federico Fortuni, Leiden University Medical Center (LUMC), Netherlands *CORRESPONDENCE Luigi P. Badano l.badano@auxologico.it SPECIALTY SECTION This article was submitted to Cardiovascular Imaging, a section of the journal Frontiers in Cardiovascular Medicine RECEIVED 09 October 2022 ACCEPTED 09 December 2022 PUBLISHED 22 December 2022 CITATION Muraru D, Baldea SM, Genovese D, Tomaselli M, Heilbron F, Gavazzoni M, Radu N, Sergio C, Baratto C, Perelli F, Curti E, Parati G and Badano LP (2022) Association of outcome with left ventricular volumes and ejection fraction measured with two- and three-dimensional echocardiography in patients referred for routine, clinically indicated studies. Front. Cardiovasc. Med. 9:1065131. doi: 10.3389/fcvm.2022.1065131 COPYRIGHT © 2022 Muraru, Baldea, Genovese, Tomaselli, Heilbron, Gavazzoni, Radu, Sergio, Baratto, Perelli, Curti, Parati and Badano. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Association of outcome with left ventricular volumes and ejection fraction measured with two- and three-dimensional echocardiography in patients referred for routine, clinically indicated studies Denisa Muraru 1,2 , Sorina Mihaila Baldea 3 , Davide Genovese 4 , Michele Tomaselli 2 , Francesca Heilbron 2 , Mara Gavazzoni 2 , Noela Radu 3 , Caravita Sergio 2,5 , Claudia Baratto 1,2 , Francesco Perelli 1 , Emanuele Curti 1 , Gianfranco Parati 2 and Luigi P. Badano 1,2 * 1 Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy, 2 Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy, 3 Department of Cardiology, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania, 4 Cardiology Unit, Cardio-Neuro-Vascular Department, Ca’ Foncello Hospital, Treviso, Italy, 5 Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy Objectives: We sought to analyze if left ventricular (LV) volumes and ejection fraction (EF) measured by three-dimensional echocardiography (3DE) have incremental prognostic value over measurements obtained from two- dimensional echocardiography (2DE) in patients referred to a high-volume echocardiography laboratory for routine, clinically-indicated studies. Methods: We measured LV volumes and EF using both 2DE and 3DE in 725 consecutive patients (67% men; 59 ± 18 years) with various clinical indications referred for a routine clinical study. Results: LV volumes were significantly larger, and EF was lower when measured by 3DE than 2DE. During follow-up (3.6 ± 1.2 years), 111 (15.3%) all-cause deaths and 248 (34.2%) cardiac hospitalizations occurred. Larger LV volumes and lower EF were associated with worse outcome independent of age, creatinine, hemoglobin, atrial fibrillation, and ischemic heart diseases). In stepwise Cox regression analyses, the associations of both death and cardiac hospitalization with clinical data (CD: age, creatinine, hemoglobin, atrial fibrillation, and ischemic heart disease) whose Harrel’s C-index (HC) was 0.775, were augmented more by the LV volumes and EF obtained by 3DE than by 2DE parameters. The association of CD with death was not affected by LV end-diastolic volume (EDV) either measured by 2DE or 3DE. Conversely, it was incremented by 3DE LVEF (HC = 0.84, p < 0.001) more Frontiers in Cardiovascular Medicine 01 frontiersin.org