Purpose: Sigmoid-shaped ventricular septum (SS), a frequently encountered minor abnormality in echocardiographic examinations of the elderly, may have some influence on RV shape. We aimed to determine the influence of SS on the accuracy of the 6 RV linear diameter measurements in the light of three-dimensional echocardiographic (3DE) RV volume. Subjects and Methods: The aorto-septal angle (ASA) was measured in the parasternal long-axis view using two-dimensional echocardiography (2DE) as an index of SS in 70 patients without major cardiac abnormalities who were subdivided into 35 with SS (ASA ≤120 degree) and 35 without SS (NSS). We measured RV end-diastolic volume (RVEDV) using 3DE; in addition, using 2DE, we measured basal RV diameter, mid-cavity diameter, longitudinal diameter and end-diastolic area in the apical four-chamber view; proximal RV outflow tract (RVOT) diameter in the parasternal long-axis view; and proximal and distal RVOT diameters in the parasternal short-axis view. Results: RVEDV did not differ between the SS and NSS groups. The SS group had greater basal RV diameter and proximal and distal RVOT diameters than the NSS group. RV mid-cavity diameter, longitudinal diameter, and end-diastolic area did not differ between the groups. Among the 2DE parameters of RV size, RV end-diastolic area was most strongly correlated with RVEDV (r=0.67), followed by RV mid-cavity diameter (r=0.58). Conclusion: When SS is present, the echocardiographic basal RV diameter and RVOT diameters overestimate RV size, and the measurement of RV end-diastolic area and mid-cavity diameter more correctly reflect 3D RV volume.

The purpose of this study was to test whether the fractional change in the endocardial border length between end-diastolic and end-systole as manually traced in left ventricular ejection fraction (LVEF) measurement using the biplane method of discs (MOD) consistent with the global longitudinal strain derived from speckle-tracking echocardiography.Methods: For 105 patients who underwent echocardiography, two-and four-chamber images with manually traced endocardial lines for LVEF measurement by MOD were stored. LV endocardial lengths at end-diastole and at end-systole were measured on both images to calculate the fractional length changes, which were averaged (GLS MOD ). Speckle-tracking analysis was performed to measure global longitudinal strains in the apical two-and four-chamber and long-axis images, and the three values were averaged (GLS STE ) according to the ASE and EACVI guidelines.Results: There was no significant difference between GLS MOD and GLS STE . GLS MOD correlated well with GLS STE (r=0.81, p<0.001), and there was no fixed bias in the Bland-Altman analysis.The intraclass correlations for the intra-and inter-observer comparisons for GLS STE were excellent and those for GLS MOD were adequate. Conclusion:The fractional LV endocardial border length change, GLS MOD , showed sufficient agreement with GLS STE to justify its use as a substitute for the STE-derived global longitudinal strain.