Three‐dimensional echocardiography to identify right ventricular dilatation in patients with corrected Fallot anomaly or pulmonary stenosis

Abstract

Background 3‐Dimensional Echocardiography allows measuring volumes and parameters of myocardial deformation (strain). Myocardial strain has been suggested to be superior to conventional echo parameters in the assessment of right ventricular (RV) function. Myocardial strain can be assessed by cardiac magnetic resonance (CMR) or two‐ and three‐dimensional echocardiography (2D and 3DEcho). We performed a comprehensive assessment of the RV based on 3DEcho and compared the results with those based on CMR and 2DEcho. Methods 36 patients with corrected heart defects underwent CMR and 3DEcho to assess RV volume, strain and cardio pulmonary exercise testing with peak VO2 measurement. 2DEcho was used for reference. Results There was a moderate correlation between 3DEcho and CMR for measuring RV end‐diastolic and end‐systolic volumes (r = .82 and .72). 3DEcho tended to underestimate the RV volumes, mean difference EDV 8.5 ± 33 ml (CI −2.8; 19.7 ml) and ESV 13.2 ± 29 ml (CI 3.3; 23 ml). According to method‐specific reference values for RVEDV, 34/35 (3DEcho) and 29/36 (CMR) were dilated. Among those dilated according to CMR, all were identified by 3DEcho. The coefficient of correlation between RV atrioventricular plane displacement measured by CMR and tricuspid annular plane systolic excursion measured by 3D and 2DEcho was r = .6 for both. 2DEcho measured lower LV volumes than CMR. LVEF and GLS were similar in 2DEcho, 3DEcho and CMR. Patients with CMR‐determined RV free wall strain ≤ −14% tended to have lower peak VO2. Conclusions Although 3DEcho underestimated RV volumes, it successfully identified all patients with RV dilatation based on method‐specific reference values.

Three-Dimensional Echocardiography Assessment of Right Ventricular Volumes and Function: Technological Perspective and Clinical Application

“…The correlation coefficients are almost above 0.7 for RV volumes (RVEDV and RVESV). The 3DE underestimates the RV volumes [13,16,19,28,[36][37][38][39]41,43,46,48,49,52,56], except in the case of Muraro, D. et al study for which RVESV was overestimated [19]. The mean differences were as followed: −2.3 to −53 mL for RVEDV and −0.3 to −23.6 mL for RVESV.…”

“…The correlation coefficients of 3DE-derived RVEF with CMR values in most of the studies exceed 0.75, and the mean difference for RVEF between 3DE and CMR is discordant. Some studies showed that 3DE slightly underestimates the RVEF against CMR [16,28,36,39,41,43,46,49,56]. The mean bias for RVEF ranged from −0.3% to −17.0%.…”

Assessment of Right Ventricular-Arterial Coupling by Echocardiography in Patients with Right Ventricular Pressure and Volume Overload

“…A study including corrected Fallot anomaly or pulmonary stenosis patients performed by Trzebiatowska-Krzynska et al . [ 16 ] demonstrated that 3DE successfully identified all patients with RV dilatation according to CMRI. In addition, the reproducibility analysis results showed that limits of agreement of 3D data, such as EDV, ESV and RVEF, were narrow in this research population.…”

Real-time Three-dimensional Echocardiography: A Feasible and Accurate Method for Measuring Right Ventricular Function in Pulmonary Hypertension

“…As stated earlier, RV function is an independent predictor of clinical outcomes in patients with PAH. Most studies reported a lower estimation of RVEF by 3DE in comparison with CMR [22,26,29,30,32,47] except the study of Bhave et al, [44] where a slight overestimation was found in comparison with CMR. Similar trends were observed in the case of patients with PH who underwent 3DE.…”