Real-Time Three-Dimensional Echocardiography to Assess Right Ventricle Function in Patients with Pulmonary Hypertension

PLOS ONE, Dec 2019

Background 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 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. Methods 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 (S′). 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. Results Regarding the measurements taken by 2DE, RVEF positively correlated with fractional area change (r = 0.595, P = 0.003) and S′(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. Conclusion RT3DE was a viable method for noninvasive, accurate assessment of right ventricular systolic function in patients with pulmonary hypertension.

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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. - 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)


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Yidan Li, Yidan Wang, Zhenguo Zhai, Xiaojuan Guo, Yuanhua Yang, Xiuzhang Lu. Real-Time Three-Dimensional Echocardiography to Assess Right Ventricle Function in Patients with Pulmonary Hypertension, PLOS ONE, 2015, 6, DOI: 10.1371/journal.pone.0129557