Real-Time Three-Dimensional Echocardiography to Assess Right Ventricle Function in Patients with Pulmonary Hypertension
June
Real-Time Three-Dimensional Echocardiography to Assess Right Ventricle Function in Patients with Pulmonary Hypertension
Yidan Li 0 1
Yidan Wang 0 1
Zhenguo Zhai 0 1
Xiaojuan Guo 0 1
Yuanhua Yang 0 1
Xiuzhang Lu 0 1
0 1 Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University , Beijing, 100020, China , 2 Department of Respiratory Medicine, Beijing Chao Yang Hospital, Capital Medical University , Beijing, 100020, China , 3 Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Institute of Respiratory Medicine, Capital Medical University , Beijing , China , 4 Department of Radiology, Beijing Chao Yang Hospital, Capital Medical University , Beijing, 100020 , China
1 Academic Editor: Xiongwen Chen, Temple University , UNITED STATES
Patients with pulmonary hypertension (n = 23) underwent cardiac magnetic resonance, 2DE, and RT3DE. Specifically, 2DE was used to measure the right ventricular index of myocardial performance (RIMP), fractional area change, tricuspid annular plane systolic excursion (TAPSE), and tissue Doppler-derived tricuspid annular systolic velocity (S0). Cardiac magnetic resonance and RT3DE were used to measure right ventricular end-diastolic volume (RVEDV) and end-systolic volume (RVESV). The right ventricular ejection fraction (RVEF) was calculated.
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Competing Interests: The authors have declared
that no competing interests exist.
The convenience and availability of real-time three-dimensional echocardiography
(RT3DE) makes it an attractive candidate for assessing right ventricle function. However,
the viability of RT3DE is not conclusive.
Aim of Study Methods
This study aims to evaluate RT3DE relative to cardiac magnetic resonance and
2-dimensional echocardiography (2DE) for measuring right ventricular systolic function in patients
with pulmonary hypertension.
Regarding the measurements taken by 2DE, RVEF positively correlated with fractional area
change (r = 0.595, P = 0.003) and S0(r = 0.489, P = 0.018), and negatively correlated with RIMP
(r = −0.745, P = 0.000). There was no association between RVEF and TAPSE (r = −0.029,
P = 0.896). There existed a close correlation between the values of RVEDV, RVESV, and
RVEF as measured by RT3DE and CMR respectively (P<0.001); Bland-Altmanan analyses
showed good agreement between them.
RT3DE was a viable method for noninvasive, accurate assessment of right ventricular
systolic function in patients with pulmonary hypertension.
Most patients with pulmonary hypertension have marked right ventricle (RV) dysfunction. In
many pathological conditions, RV function is an important predictor of prognosis, as it is
strongly associated with clinical outcomes, disease severity, and patient health-related quality
of life. Thus, accurate assessment of RV structure and function is crucial to the management of
patients with pulmonary hypertension.
Two-dimensional (2D) echocardiography (2DE) is the most commonly used clinical imaging
method for functional evaluation of the right ventricle. With 2DE, the complex geometry
structure of the RV, with both a crescent shape and an outspread inflow and outflow tract requires
several scan planes for the estimation of RV size and function. However, M-Mode and tissue
Doppler imaging of the free lateral wall of the RV are measured in one plane clinically, and are
used as surrogates for RV function. Hence, current echocardiographic techniques are not
suitable for calculating right ventricular volumes and function accurately with a simple algorithm
[1]. Real-time three-dimensional (3D) echocardiography (RT3DE) is able to display the 3D
anatomy of the RV; simultaneously depicting both longitudinal and transverse movements [2].This
feature makes it superior to conventional two-dimensional methods in RV function assessment.
However, the feasibility and accuracy of RT3DE has not been fully studied.
Cardiac magnetic resonance imaging (CMR) provides multilane, high-contrast,
high-resolution images that can be analyzed without reliance on geometric assumptions for assessing the
right ventricle. CMR is used to determine the RV end-diastolic and end-systolic volumes, to
calculate RV ejection fraction (RVEF) [3]. In this study, to determine the feasibility and accuracy of
RT3DE for measuring the RV function of patients with pulmonary hypertension, RT3DE was
evaluated relative to CMR for measuring right ventricular global volume and systolic function.
We studied 23 consecutive adult patients with pulmonary hypertension at Beijing Chaoyang
Hospital between October 2013 and July 2014, who were naive to pulmonary hypertension
management. The cohort consisted of 13 patients with chronic thromboembolic pulmonary
hypertension, 8 with idiopathic pulmonary arterial hypertension, and 2 with connective tissue
diseases associated with pulmonary arterial hypertension. All these patients underwent both
RT3DE and CMR to assess right ventricular function, at the basis of 2DE in accor (...truncated)