Optimizing right ventricular focused four-chamber views using three-dimensional imaging, a comparative magnetic resonance based study
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Obtaining focused right ventricular (RV) apical view remains challenging using conventional two-dimensional (2D) echocardiography. This study main objective was to determine whether measurements from RV focused views derived from three-dimensional (3D) echocardiography (3D-RV-focused) are closely related to measurements from magnetic resonance (CMR). A first cohort of 47 patients underwent 3D echocardiography and CMR imaging within 2 h of each other. A second cohort of 25 patients had repeat 3D echocardiography to determine the test–retest characteristics; and evaluate the bias associated with unfocused RV views. Tomographic views were extracted from the 3D dataset: RV focused views were obtained using the maximal RV diameter in the transverse plane, and unfocused views from a smaller transverse diameter enabling visualization of the tricuspid valve opening. Measures derived using the 3D-RV-focused view were strongly associated with CMR measurements. Among functional metrics, the strongest association was between RV fractional area change (RVFAC) and ejection fraction (RVEF) (r = 0.92) while tricuspid annular plane systolic excursion moderately correlated with RVEF (r = 0.47), all p < 0.001. Among RV size measures, the strongest association was found between RV end-systolic area (RVESA) and volume (r = 0.87, p < 0.001). RV unfocused views led on average to 10% underestimation of RVESA. The 3D-RV-focused method had acceptable test–retest characteristics with a coefficient of variation of 10% for RVESA and 11% for RVFAC. Deriving standardized RV focused views using 3D echocardiography strongly relates to CMR-derived measures and may improve reproducibility in RV 2D measurements.
KeywordsRight heart imaging Three-dimensional echocardiography Cardiac magnetic resonance Quality control
The authors would like to thank Paul Kim and Semhar Sibhatu (Stanford University for their help in data collection, and Allan Paloma (from Stanford Cardiovascular Echocardiography Laboratory) for his technological expertise and knowledge.
This study was funded by the Stanford Cardiovascular Institute and the Vera Moulton Wall Center of Pulmonary Hypertension at Stanford.
Compliance with ethical standards
Conflict of interest
MA received a Young Investigator Seed Grant from the Vera Moulton Wall Center. FH received funds from Pai Chan Lee Research fund. The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were approved by Stanford University Institutional Review Board in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.
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