Feasibility of single-beat full-volume capture real-time three-dimensional echocardiography for quantification of right ventricular volume: Validation by cardiac magnetic resonance imaging
Introduction
Accurate evaluation of right ventricular (RV) volume and function is of paramount clinical importance for management of many cardiac diseases due to the prognostic value of RV dilation and dysfunction in prediction of morbidity and mortality [1], [2], [3], [4], [5] Assessment of the RV is challenging with 2-dimensional (2D) imaging owing to its complex shape [6]. Three-dimensional echocardiography (3DE) allows measurement of RV volumes without geometric assumption [7], [8]. However, previous generations of 3DE technique used multiple-beat capture which are prone to stitching artifacts due to breathing motions or irregular heart rhythm of the patients [9]. With improvements in computer technology and the development of faster memory processing techniques, a new real-time 3D echocardiographic technology is available to acquire a full RV volume from a single heartbeat using the onboard RV analysis program. This technique also incorporates automated volumetric cardiac ultrasound analysis with pattern recognition technology. In this study, we sought to assess the feasibility of single-beat full-volume 3DE for RV volume measurement in clinical practice and to validate against cardiac magnetic resonance imaging (CMR).
Section snippets
Study population
We enrolled 61 patients in sinus rhythm who were scheduled for both CMR and echocardiography for various indications on the same day. The protocol was approved by the General Hospital of Tai Gang, Shanxi Medical University review board.
Two dimensional echocardiography
An experienced sonographer acquired apical 4-chamber views with focused acquisition of the RV (Acuson SC2000 system; Siemens Medical Solutions USA, Inc., Mountain View, CA). Measurements of RV end-diastolic area (EDA; defined as the maximal RV cavity size just
Statistical analysis
The statistical analysis was performed using a dedicated software (SPSS 14.0 for Windows, SPSS Inc, Chicago, IL). All values were expressed as mean ± SD or number (percentages) as appropriate. Linear regression, intraclass correlation, Bland-Altman analysis, and measurement of coefficients of variation were used for comparisons between measurements by 3D echocardiography and CMR. Interobserver and intraobserver variability of real-time 3D echocardiographic measurements of EDV, ESV and EF were
Feasibility of RT3DE using the single-beat full-volume capture system
Of the 61 patients enrolled in this study, 16 patients had normal hearts, 20 patients had hypertensive cardiomyopathy, 9 patients had ischemic cardiomyopathy, and 14 patients had pulmonary disease. Two patients were excluded from final volume validation because of inadequate 3DE image quality (both patients had pulmonary disease). Overall, the 3DE data sets of 59 patients had adequate image quality for analysis, and the feasibility of single-beat full-volume RV capture with 3DE was 97%.
Discussion
We found that real time full-volume capture 3DE was an accurate method to assess RV volume and EF compared with CMR measurements. With the development of this new technique, it may become more feasible for real time 3DE to be adopted into clinical practice [10], [11], [12]. The RV is a geometrically more complex structure than the LV. There are numerous published techniques for echocardiographic measurement of RV function [13], [14], [15]. However, conventional 2D echocardiographic techniques
Limitations
Although CMR is currently considered the best method to measure in vivo cardiac volume, it also has its own limitations due to partial volume effect and the possible error from through-plane motion of right ventricle when calculated from RV images, especially right ventricular out flow tract.
The real benefit of single-beat capture real time 3DE may be present in patients with atrial fibrillation or ectopic rhythm, did not test this feasibility in this study.
Full validation of this new technique
Conclusions
Real-time 3DE by single-beat full-volume capture is an accurate method to assess RV volume and EF compared with CMRI measurements. This new technique may enhance the feasibility of 3DE to be adopted into current clinical practice. However, the accuracy of measurements mainly depends on the experience of the sonographers and the limitation of the 3D matrix angle in dilated RV.
References (21)
- et al.
Comparison of mortality rates and progression of left ventricular dysfunction in patients with idiopathic dilated cardiomyopathy and dilated versus non dilated right ventricular cavities
Am J Cardiol
(1997) - et al.
Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure
J Am Coll Cardiol
(1998) - et al.
Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure
J Am Coll Cardiol
(2001) - et al.
Normal values of right ventricular size and function by real-time 3-dimensional echocardiography: comparison with cardiac magnetic resonance imaging
J Am Soc Echocardiogr
(2007) - et al.
Clinical value of real-time three-dimensional echocardiography for right ventricular quantification in congenital heart disease: Validation with cardiac magnetic resonance imaging
J Am Soc Echocardiogr
(2010) - et al.
Reconstructed versus real-time 3-dimensional echocardiography: comparison with magnetic resonance imaging
J Am Soc Echocardiogr
(2007) - et al.
Feasibility of single-beat full-volume capture real-time three-dimensional echocardiography and auto-contouring algorithm for quantification of left ventricular volume: validation with cardiac magnetic resonance imaging
J Am Soc Echocardiogr
(Aug 2011) - et al.
The relation between quantitative right ventricular ejection fraction and indices of tricuspid annular motion and myocardial performance
J Am Soc Echocardiogr
(2004) - et al.
Assessment of right ventricular function in patients with congestive heart failure by echocardiographic automated boundary detection
Am J Cardiol
(1996) - et al.
Reproducibility of right ventricular volumes and ejection fraction using real-time 3-dimensional echocardiography. Comparison with cardiacMRI
Chest
(2007)
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