Chest
Volume 131, Issue 6, June 2007, Pages 1844-1851
Journal home page for Chest

ORIGINAL RESEARCH
PULMONARY VASCULAR DISEASE
Reproducibility of Right Ventricular Volumes and Ejection Fraction Using Real-time Three-Dimensional Echocardiography: Comparison With Cardiac MRI

https://doi.org/10.1378/chest.06-2143Get rights and content

Objectives

The nongeometric nature of the right ventricle (RV) makes it difficult to measure. We sought to determine whether real-time three-dimensional echocardiography (RT3DE) is superior to two-dimensional echocardiography (2DE) for the follow-up of RV function by validation vs cardiac MRI.

Methods

RV volumes and ejection fraction (EF) were studied with 2DE (including area-length [A-L], the modified two-dimensional subtraction [2DS] method, and the Simpson method of discs), RT3DE, and MRI in 50 patients with left ventricular wall motion abnormalities, the results of which suggested possible RV infarction. Test-retest variation was performed by a complete restudy using a separate sonographer within 24 h without the alteration of hemodynamics or therapy. Interobserver and intraobserver variations were noted in a subgroup of 20 patients.

Results

EF estimations were similar using each technique. The mean (± SD) MRI end-diastolic volume (87 ± 22 mL) was only slightly underestimated by RT3DE (mean difference, −3 ± 10; p < 0.05), with a greater mean difference for 2DE A-L (−29 ± 10; p < 0.05), and the Simpson method of discs (−29 ± 23; p < 0.05), and was greatly overestimated by 2DS (mean difference, 26 ± 23; p < 0.05). Similarly, the mean MRI end-systolic volume (46 ± 17 mL) was only slightly underestimated by RT3DE (−4 ± 7; p < 0.05), compared with 2DE A-L (−16 ± 8; p < 0.05) and the Simpson method of discs (−16 ± 8; p < 0.05), and was overestimated by 2DS (14 ± 13; p < 0.05). RT3DE findings had a higher correlation with each parameter than any 2DE technique. There was also good intraobserver and interobserver correlation between RT3DE by two sonographers. RT3DE had less test-retest variation of RV volumes and EF than any 2DE measure.

Conclusions

RT3DE is more accurate than two-dimensional approaches and reduces the test-retest variation of RV volumes and EF measurements in follow-up RV assessment.

Section snippets

Study Design

We prospectively recruited patients who had been referred to the echocardiography laboratory for the assessment of cardiac structure and function after experiencing an acute myocardial infarction, and who were scheduled to undergo 2DE, RT3DE, and MRI. In 54 patients (47 men; mean [± SD] age, 63 ± 10 years), RV involvement was suspected from standard imaging, and an additional medial RV view was obtained using RT3DE (see “RT3DE” section below). The investigations were approved by the Human

Patient Characteristics

Of the 54 original patients, 2 were excluded from RT3DE as they were unable to hold their breath during acquisition, and another 2 were excluded from the MRI validation due to claustrophobia. Therefore, the results of the MRI, RT3DE, and 2DE were analyzed in 50 patients (43 men; mean age, 62 ± 11 years). All patients had LV regional wall motion abnormalities, with 70% of patients undergoing angiography. The majority had multivessel coronary artery disease (defined by > 70% stenosis in more than

Discussion

The results of this study of patients with ischemic LV dysfunction and suspicion of RV involvement indicate that RV volume measurements using RT3DE imaging are comparable with MRI. RT3DE also provides low test-retest variation and high reproducibility of RV measurements between observers.

Conclusions

In this study, RT3DE was the most accurate echocardiographic technique used for the measurement of RV volumes in subjects with LV dysfunction. It also appears to be a feasible follow-up imaging tool for sequential measurements of the RV volumes and function.

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  • Cited by (0)

    Supported in part by a grant-in-aid from the National Health and Medical Research Council of Australia.

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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