3D Echo systematically underestimates right ventricular volumes compared to cardiovascular magnetic resonance in adult congenital heart disease patients with moderate or severe RV dilatation

Abstract

BackgroundThree dimensional echo is a relatively new technique which may offer a rapid alternative for the examination of the right heart. However its role in patients with non-standard ventricular size or anatomy is unclear. This study compared volumetric measurements of the right ventricle in 25 patients with adult congenital heart disease using both cardiovascular magnetic resonance (CMR) and three dimensional echocardiography.MethodsPatients were grouped by diagnosis into those expected to have normal or near-normal RV size (patients with repaired coarctation of the aorta) and patients expected to have moderate or worse RV enlargement (patients with repaired tetralogy of Fallot or transposition of the great arteries). Right ventricular end diastolic volume, end systolic volume and ejection fraction were compared using both methods with CMR regarded as the reference standardResultsBland-Altman analysis of the 25 patients demonstrated that for both RV EDV and RV ESV, there was a significant and systematic under-estimation of volume by 3D echo compared to CMR. This bias led to a mean underestimation of RV EDV by -34% (95%CI: -91% to + 23%). The degree of underestimation was more marked for RV ESV with a bias of -42% (95%CI: -117% to + 32%). There was also a tendency to overestimate RV EF by 3D echo with a bias of approximately 13% (95% CI -52% to +27%).ConclusionsStatistically significant and clinically meaningful differences in volumetric measurements were observed between the two techniques. Three dimensional echocardiography does not appear ready for routine clinical use in RV assessment in congenital heart disease patients with more than mild RV dilatation at the current time.

Three-Dimensional Echocardiography Compared With Computed Tomography to Determine Mitral Annulus Size Before Transcatheter Mitral Valve Implantation

“…Other annular measurements are also made directly onto the short-axis view not taking into account the true nonplanar configuration 3D echocardiography can underestimate measurements compared with other imaging modalities, such as CT 26 and magnetic resonance imaging. 27 This may be due in part to suboptimal lateral resolution in the coronal plane of 3D echocardiography, which reduces the ability to discriminate the blood/ tissue interface. 26 Nonetheless, this study demonstrated good agreement between MA dimensions derived by 3D-TEE and CT.…”

Use of Cardiac Magnetic Resonance and Echocardiography in Population-Based Studies

“…To what extent the use of 3D imaging has improved the accuracy of echocardiographic examination of RV size and function is less clear. Ongoing concerns regarding 30% to 40% underestimation of RV volumes by 3D echocardiography 13 are difficult to reconcile with a recent meta-analysis that reported a small (but still significant) underestimation of CMR-derived RV volumes by 3D echocardiographic methods in multiple recent human studies.…”

Cavity Segmentation and Stroke Volume Measurement Methods From Echocardiographic Images: Review

“…In a comparison study of the RV volume measurement of using 3DE and MRI imaging, Crean et al (2011) acquired RV from a modified four-chamber imaging view to maximize the visualization of RV. The volume reconstruction was performed from 2D multiplanar view for semi-automatic intracardial boundary detection with manual correction.…”

“…This process is a routine step of the ventricle assessment procedures, where often, in clinical reports, many parameters can be measured in these two stages to help in diagnosing and decision making Barcaro et al (2008). However, the process of detecting the ED and ES still a challenge for diagnosis because it was mostly done manually by tracking the cine loop during the clinical procedure, as in Niemann et al (2007) or by optical tracking of the change of ventricle dimensions through watching the individual image faces of the ventricle during the cardiac cycle, as in (Aune et al, 2009;Crean et al, 2011).…”