Normal Values of Right Ventricular Size and Function by Real-time 3-Dimensional Echocardiography: Comparison with Cardiac Magnetic Resonance Imaging

Gopal, Aasha S.; Chukwu, Ebere O.; Iwuchukwu, Chizor; Katz, Alan S.; Toole, Rena; Schapiro, William; Reichek, Nathaniel

doi:10.1016/j.echo.2006.10.027

Cited by 178 publications

(121 citation statements)

References 41 publications

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“…Indeed, RV volume measurements were affected by multiple factors, including gain settings and thickness and orientation of disks used by the disk summation technique. 49,50 Another potential source of intermodality discordance is that the complex 3D shape of the right ventricle may affect the ability of CMR imaging to accurately quantify RV volumes. In particular, the identification of RV boundaries near the RV outflow tract may be quite challenging from short-axis slices perpendicular to the long axis of the left ventricle, which is the standard for CMR image acquisition.…”

Section: Rt3de Evaluation Of Right Ventricular Volumes and Functionmentioning

confidence: 99%

Real-Time 3-Dimensional Echocardiography

2009

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O ne of the most significant developments of the last decade in ultrasound imaging of the heart was the evolution of 3-dimensional (3D) imaging from slow and labor-intense offline reconstruction to real-time volumetric imaging. This imaging modality provides valuable clinical information that empowers echocardiographers with new levels of confidence in the diagnosis of heart disease. We have previously described the technological milestones in the development of real-time 3D echocardiographic (RT3DE) imaging and its major advantages over conventional 2-dimensional echocardiography (2DE) and reviewed the published literature that supported the use of this new methodology in clinical practice. 1 Since 2006, the growing availability of RT3DE technology, its ease of use, and its multiple attractive features have sparked significant interest in the research community, resulting in a large number of publications, most of which have endorsed RT3DE imaging for clinical use by demonstrating its unique capabilities in different scenarios. In parallel, the clinical acceptance of this new tool has broadened significantly. The most recent clinically significant addition is matrix-array transesophageal echocardiography (TEE), which provides images of unprecedented quality that aid surgeons and interventional cardiologists in planning and guiding procedures and evaluating their outcomes.The purpose of the present article is to review the most recent RT3DE literature and provide readers with an update on the latest developments and the current status of this noninvasive imaging tool. Because different potential applications of RT3DE imaging have been explored to various extents, they are described here separately, and each is discussed with an emphasis on the scientifically established facts, along with the known stumbling blocks and difficulties. Quantification of LV Volumes and FunctionA firmly established advantage of 3D imaging over crosssectional slices of the heart is the improvement in the accuracy of the evaluation of left ventricular (LV) volumes and ejection fraction (EF) by eliminating the need for geometric modeling, which is inaccurate in the presence of aneurysms, asymmetrical ventricles, or wall motion abnormalities, and the errors caused by foreshortened views even in symmetrical ventricles. The value of RT3DE imaging in this context has been demonstrated by multiple studies that compared RT3DE volume measurements with widely accepted reference techniques, including radionuclide ventriculography and cardiac magnetic resonance (CMR). [2][3][4][5][6] These studies and others have demonstrated higher levels of agreement between the RT3DE approach and the respective reference technique compared with conventional 2DE methodology. Additionally, RT3DE measurements were found to be more reproducible than 2DE 4,5,7 and, in some studies, even as reproducible as CMR. 8 Interestingly, in a recent study in patients after myocardial infarction (MI), 9 RT3DE-derived LV volumes were more accurate and more reproducible than thos...

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Section: Rt3de Evaluation Of Right Ventricular Volumes and Functionmentioning

confidence: 99%

Real-Time 3-Dimensional Echocardiography

2009

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“…29,30 Our findings confirm previous studies reporting a slight systematic underestimation of RV volumes by 3DE in comparison with CMR. 26,31 The potential source of bias has been documented in both in vivo and in vitro studies. 18,32 Despite the bias in absolute values, the role of aging, sex, and anthropometric variables as determinants of RV size and function demonstrated by Maceira et al 29 using steady-state free precession CMR is in complete agreement with our findings.…”

mentioning

confidence: 99%

“…Furthermore, the analysis algorithm used in this study has been extensively validated against CMR. 14,26,31,32 Moreover, limited availability and costs of CMR as well as ethical reasons prevented its use for studying healthy subjects having no clinical indication for CMR examination. The inclusion of weight as a predictor may be questionable as it may change rapidly in adults.…”

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confidence: 99%

Age-, Body Size-, and Sex-Specific Reference Values for Right Ventricular Volumes and Ejection Fraction by Three-Dimensional Echocardiography

Maffessanti

Muraru

Esposito

et al. 2013

Circ: Cardiovascular Imaging

206

142

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R ight ventricular (RV) volumes and ejection fraction (EF)are important determinants of survival in patients with myocardial infarction, 1 systolic heart failure, 2-4 congenital heart disease, 5 and pulmonary arterial hypertension.6 Clinical Perspective on p 710Cardiac magnetic resonance (CMR) is the current gold standard for quantitation of RV geometry and function, but its widespread use is limited by costs, time consumption, and contraindications, making it unsuitable for patient screening or monitoring on large scale.One of the major breakthroughs of transthoracic threedimensional echocardiography (3DE) is the ability to measure RV volumes and EF, otherwise not feasible by standard two-dimensional (2D) echocardiography. 7 However, recent recommendations for RV quantitation 8 indicated that limited normative data are currently available for 3DE and, despite significant differences by age and sex for RV geometry and function were identified by CMR, 9 no reliable age-or sexspecific reference values can be recommended at present for 3DE. Paralleling the findings obtained with CMR, 9 we hypothesized that RV volumes and EF measured by 3DEBackground-Right ventricular (RV) volumes and ejection fraction (EF) vary significantly with demographic and anthropometric factors and are associated with poor prognosis in several cardiovascular diseases. This multicenter study was designed to (1) establish the reference values for RV volumes and EF using transthoracic three-dimensional (3D) echocardiography; (2) investigate the influence of age, sex, and body size on RV anatomy; (3) develop normative equations. Methods and Results-RV volumes (end-diastolic volume and end-systolic volume), stroke volume, and EF were measured by 3D echocardiography in 540 healthy adult volunteers, prospectively enrolled, evenly distributed across age and sex. The relation of age, sex, and body size parameters was investigated using bivariate and multiple linear regression. Analysis was feasible in 507 (94%) subjects (260 women; age, 45±16 years; range, 18-90). Age, sex, height, and weight significantly influenced RV volumes and EF. Sex effect was significant (P<0.01), with RV volumes larger and EF smaller in men than in women. Older age was associated with lower volumes (end-diastolic volume, −5 mLdecade; endsystolic volume, −3 mL/decade; EF, −2 mL/decade) and higher EF (+1% per decade). Inclusion of body size parameters in the statistical models resulted in improved overall explained variance for volumes (end-diastolic volume, R 2 =0.43; end-systolic volume, R 2 =0.35; stroke volume, R 2 =0.30), while EF was unaffected. Ratiometric and allometric indexing for age, sex, and body size resulted in no significant residual correlation between RV measures and height or weight. Conclusions-The MethodsHealthy volunteers were prospectively enrolled in 3 Italian tertiary centers (C1, C2, C3) having a large expertise in 3DE for RV quantification (>400 studies/y per center for both clinical and research purposes). Participating centers were asked to provi...

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“…7). 3DE measurements are closely correlated (but slightly underestimate) with RV volumes measured by CMR both in children and adults [18][19][20][21], and by volumetric thermodilution during cardiac catheterisation [22]. Normative data for 3DE RV volumes and ejection fraction (EF) including age-, body size-, and sex-specific reference values based on large cohort studies of healthy volunteers have recently become available (Table 2) [23,24].…”

Section: Quantitative Assessmentmentioning

confidence: 99%