Reference Values for Right Ventricular Volumes and Ejection Fraction With Real-Time Three-Dimensional Echocardiography: Evaluation in a Large Series of Normal Subjects

Tamborini, Gloria; Marsan, Nina Ajmone; Gripari, Paola; Maffessanti, Francesco; Brusoni, Denise; Muratori, Manuela; Caiani, Enrico G.; Fiorentini, Cesare; Pepi, Mauro

doi:10.1016/j.echo.2009.11.026

Cited by 162 publications

(107 citation statements)

References 31 publications

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“…Of note, D'Oronzio et al 25 reported only a weak inverse association between aging and RV area, which may be due to the lower accuracy of 2D echocardiography in comparison with 3DE in assessing RV size. 26 Our study corroborates and extends the results of Tamborini et al 10 to a larger population, investigating the demographic and anthropometric determinants of RV morphology and function in a multicenter setting. This is an important step toward the definition of clinically applicable reference ranges.…”

supporting

confidence: 79%

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

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203

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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supporting

confidence: 79%

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

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203

142

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“…Normal values with this technique for RV size and function in adults have been published. 123 Three-dimensional echocardiography outperformed 2D echocardiography in the assessment of RV volumes and compared favorably with cardiac MRI. 124 In adults with PAH, good correlation was found in the calculation of RVEF and RVEDV determined by either 3D echocardiography or MRI measurements.…”

Section: D Echocardiographymentioning

confidence: 99%

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

et al. 2016

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Transthoracic echocardiography (TTE) is the most accessible noninvasive diagnostic procedure for the initial assessment of pediatric pulmonary hypertension (PH). This review focuses on principles and use of TTE to determine morphologic and functional parameters that are also useful for follow-up investigations in pediatric PH patients. A basic echocardiographic study of a patient with PH commonly includes the hemodynamic calculation of the systolic pulmonary artery pressure (PAP), the mean and diastolic PAP, the pulmonary artery acceleration time, and the presence of a pericardial effusion. A more detailed TTE investigation of the right ventricle (RV) includes assessment of its size and function. RV function can be evaluated by RV longitudinal systolic performance (e.g., tricuspid annular plane systolic excursion), the tricuspid regurgitation velocity/right ventricular outflow tract velocity time integral ratio, the fractional area change, tissue Doppler imaging-derived parameters, strain measurements, the systolic-to-diastolic duration ratio, the myocardial performance (Tei) index, the RV/left ventricle (LV) diameter ratio, the LV eccentricity index, determination of an enlarged right atrium and RV size, and RV volume determination by 3-dimensional echocardiography. Here, we discuss the potential use and limitations of TTE techniques in children with PH and/or ventricular dysfunction. We suggest a protocol for TTE assessment of PH and myocardial function that helps to identify PH patients and their response to pharmacotherapy. The outlined protocol focuses on the detailed assessment of the hypertensive RV; RV-LV crosstalk must be analyzed separately in the evaluation of different pathologies that account for pediatric PH.

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“…[10][11][12] Recent studies have validated the accuracy of 3DTTE-determined RV volumes and RVEF against CMR 13,14 and determined the reference values of RV volumes and RVEF in healthy subjects. 15,16 However, the prognostic value of RVEF is largely unknown. We hypothesized that RVEF assessed by 3DTTE (3DRVEF) would offer incremental value over left ventricular (LV) functional parameters for predicting future cardiac events.…”

mentioning

confidence: 99%

Prognostic Value of Right Ventricular Ejection Fraction Assessed by Transthoracic 3D Echocardiography

Nagata

Kado

et al. 2017

Circ: Cardiovascular Imaging

142

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R ight ventricular (RV) function is closely coupled with subsequent morbidity and mortality in patients with diseases affecting the right heart chambers. [1][2][3][4][5][6][7] The most common cause of RV dysfunction is chronic left-sided heart failure. Complex factors such as pulmonary hypertension, intrinsic myocardial involvement, ventricular interdependence, and myocardial ischemia lead to RV dysfunction. 1 Therefore, assessment of RV function is clinically important in almost all patients with heart disease. However, the complex geometry of the RV poses a significant limitation to the reliable quantitation of RV volumes and ejection fraction (RVEF) using 2-dimensional transthoracic echocardiography. Although cardiac magnetic resonance (CMR) imaging is the gold standard for the evaluation of RV volumes and RVEF, 8,9 factors such as cost, portability, time consumption, and contraindications hinder its routine use in every patient. Three-dimensional transthoracic echocardiography (3DTTE) has the advantage of full-volume acquisition of the entire right ventricle, which may overcome the technical and clinical limitations of 2-dimensional transthoracic echocardiography. [10][11][12] Recent studies have validated the accuracy of 3DTTE-determined RV volumes and RVEF against CMR 13,14 and determined the reference values of RV volumes and RVEF in healthy subjects. 15,16 However, the prognostic value of RVEF is largely unknown. We hypothesized that RVEF assessed by 3DTTE (3DRVEF) would offer incremental value over left ventricular (LV) functional parameters for predicting future cardiac events. See Editorial by Fernández-Golfín and Zamorano See Clinical PerspectiveAccordingly, the aims of this study were (1) to validate the accuracy of 3DTTE-determined RV volumes and RVEF against CMR reference and (2) to evaluate the prognostic value of 3DRVEF to predict future cardiac death and major adverse cardiac events (MACEs) in a large number of patients.Background-Cardiac magnetic resonance is the gold standard for the evaluation of right ventricular (RV) volumes, but it is impractical to perform in every patient. Although reference values of RV volumes and RV ejection fraction by 3D transthoracic echocardiography (3DTTE) have been established, their prognostic values have not been elucidated yet. We hypothesized that RV ejection fraction measured by 3DTTE (3DRVEF) predicts future cardiovascular events. Methods and Results-In protocol 1, we determined the accuracy of RV volumes and RV ejection fraction measurements by 3DTTE against cardiac magnetic resonance in 60 subjects. In protocol 2, 3DRVEF was measured in 446 patients with various cardiovascular diseases. Study subjects were followed up to record cardiac death and major adverse cardiovascular events. In protocol 1, 3DTTE-determined RV end-diastolic volume, end-systolic volume, and RV ejection fraction had good correlations to those by cardiac magnetic resonance (r=0.74-0.90). In protocol 2, 38 cardiac deaths and 88 major adverse cardiovascular events occurred during a med...

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Reference Values for Right Ventricular Volumes and Ejection Fraction With Real-Time Three-Dimensional Echocardiography: Evaluation in a Large Series of Normal Subjects

Cited by 162 publications

References 31 publications

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

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

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

Prognostic Value of Right Ventricular Ejection Fraction Assessed by Transthoracic 3D Echocardiography

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