Feasibility of single-beat full-volume capture real-time three-dimensional echocardiography for quantification of right ventricular volume: Validation by cardiac magnetic resonance imaging

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Abstract

Background

The lack of an accurate noninvasive method for assessing right ventricular (RV) volume and function has been a major deficiency of two-dimensional (2D) echocardiography. The aim of our study was to test the feasibility of single-beat full-volume capture with real-time three-dimensional echo (3DE) imaging system for the evaluation of RV volumes and function validated by cardiac magnetic resonance imaging (CMRI).

Methods

Sixty-one subjects (16 normal subjects, 20 patients with hypertension, 16 patients with pulmonary heart disease and 9 patients with coronary heart disease) were studied. RV volume and function assessments using 3DE were compared with manual tracing with CMRI as the reference method.

Results

Fifty-nine of 61 patients (96.7%; 36 male, mean age, 62 ± 15 years) had adequate three-dimensional echocardiographic data sets for analysis. The mean RV end diastolic volume (EDV) was 105 ± 38 ml, end-systolic volume (ESV) was 60 ± 30 and RV ejection fraction (EF) was 44 ± 11% by CMRI; and EDV 103 ± 38 ml, ESV 60 ± 28 ml and RV EF 41 ± 13% by 3DE. The correlations and agreements between measurements estimated by two methods were acceptable.

Conclusion

RV volumes and function can be analyzed with 3DE software in most of subjects with or without heart diseases, which is able to be estimated with single-beat full-volume capture with real-time 3DE compared with CMRI.

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)

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