Quantification of Right Ventricular Volume and Function Using Single-Beat Three-Dimensional Echocardiography: A Validation Study with Cardiac Magnetic Resonance

• Published in: Journal of the American Society of Echocardiography Vol. 29; no. 5; pp. 392 - 401
• Main Authors: Park, Jun-Bean, MD, Lee, Seung-Pyo, MD, PhD, Lee, Ju-Hee, MD, Yoon, Yeonyee E., MD, Park, Eun-Ah, MD, PhD, Kim, Hyung-Kwan, MD, PhD, Lee, Whal, MD, PhD, Kim, Yong-Jin, MD, PhD, Cho, Goo-Yeong, MD, PhD, Sohn, Dae-Won, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2016
• Subjects: Adult; Aged; Cardiac Imaging Techniques - methods; Cardiac magnetic resonance; Cardiac-Gated Imaging Techniques - methods; Cardiovascular; Echocardiography, Three-Dimensional - methods; Female; Humans; Hypertrophy, Right Ventricular - complications; Hypertrophy, Right Ventricular - diagnostic imaging; Image Enhancement - methods; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; Reproducibility of Results; Right ventricle; Sensitivity and Specificity; Stroke Volume; Three-dimensional echocardiography; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - etiology; RVEF; RV; sb3DE; Left ventricular; Right ventricular end-systolic volume; Right ventricular end-diastolic volume; LV; Multiple-beat three-dimensional echocardiography; Tricuspid regurgitation; RVESV; ASD; mb3DE; Atrial septal defect; Single-beat three-dimensional echocardiography; Right ventricle; Three-dimensional echocardiography; CMR; 3D; Three-dimensional; 3DE; Cardiac magnetic resonance; Right ventricular; RVEDV; Right ventricular ejection fraction; TR
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2016.01.010

Background Because of the unique geometry of the right ventricle, assessment of right ventricular (RV) volume and function is clinically challenging. The aim of this study was to investigate the feasibility of single-beat three-dimensional echocardiography (sb3DE) for RV volume and functional assessment in patients with dilated right ventricles. Methods Fifty-two patients with severe tricuspid regurgitation or atrial septal defects were enrolled. Fifty patients underwent sb3DE and cardiac magnetic resonance (CMR) within 24 hours under a euvolemic state, and the results of sb3DE were compared with those of CMR, the reference method. Fifteen normal subjects were also recruited for a broader validation of sb3DE. Results Of the 67 individuals, data from 59 study participants (44 patients and 15 normal subjects) with adequate image quality were analyzed (mean age, 46.9 ± 19.3 years; 58% women). The correlation was excellent between sb3DE and CMR for measuring RV volumes and RV ejection fraction (RVEF) ( r  = 0.96, r  = 0.93, and r  = 0.93 [ P  < .001 for all] for RV end-diastolic volume, RV end-systolic volume, and RVEF, respectively). Bland-Altman analysis revealed that RV volumes, but not RVEF, tended to be slightly underestimated by sb3DE (−5.8 ± 9.6%, −3.8 ± 14.1%, and −1.2 ± 9.4% for RV end-diastolic volume, RV end-systolic volume, and RVEF, respectively). Intra- and interobserver variability was acceptable for all indices (4.9% and 6.1% for RV end-diastolic volume, 4.2% and 7.9% for RV end-systolic volume, and 5.7% and 2.8% for RVEF, respectively). Among patients with RV dilation, the difference in RVEF between sb3DE and CMR was more pronounced in patients with atrial fibrillation than those in sinus rhythm (−5.9% vs 0.9%, P  = .041). Conclusions In patients with dilated right ventricles and in normal subjects, assessment of RV volume and systolic function by sb3DE is feasible in terms of accuracy and reproducibility. RV analysis using sb3DE can be performed in patients with atrial fibrillation, with the possibility of RVEF underestimation.