European Journal of Echocardiography Advance Access originally published online on June 6, 2009
European Journal of Echocardiography 2009 10(6):784-792; doi:10.1093/ejechocard/jep071
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Right ventricle three-dimensional echography in corrected tetralogy of fallot: accuracy and variability
1 Service des Cardiopathies Congénitales de l'Enfant et de l'Adulte, CHU de Bordeaux, Pessac, France
2 Unité d'Imagerie Thoracique et Cardiovasculaire, CHU de Bordeaux, Hôpital du Haut-Lévêque, 5 Avenue de Magellan, 33600 Pessac, France
3 Service de Cardiologie et d'Echocardiographie, CHU de Bordeaux, Pessac, France
4 Tomtec Imaging Systems, Unterschleissheim, Germany
5 Siemens Medical Solutions, Mountain View, CA, USA
Received 3 March 2009; accepted after revision 9 May 2009; online publish-ahead-of-print 6 June 2009.
* Corresponding author. Tel: +33 557 656 542; fax: +33 557 656 880. E-mail address: michel.montaudon{at}chu-bordeaux.fr
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Abstract |
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Aims: To evaluate right ventricular (RV) volume and ejection fraction (EF) in adult normal subjects and repaired tetralogy of Fallot (ToF) with 3D trans-thoracic echocardiography (3DE) and a semi-automatic border detection algorithm.
Methods and results: Fourteen healthy volunteers and 20 patients with repaired ToF (mean age 31 ± 14) underwent 3DE and MRI within the same day. Right ventricular end-systolic volume (ESV) and end-diastolic volume (EDV) and EF were measured by two observers using 3DE and compared with MRI measurements. Intra- and interobserver variability of 3DE and agreement between both methods were evaluated using Bland–Altman analysis. Over or underestimation of 3DE in comparison to MRI was assessed using paired t-test. Intra- and interobserver variability of 3DE was excellent with intraclass coefficient of correlation (ICC) ranging from 0.85 to 0.99 and from 0.85 to 0.98, respectively. Three-dimensional echocardiography underestimated ESV and EDV (P < 0.001) but agreement between 3DE and MRI was excellent (ICC = 0.88 and 0.87, respectively). Ejection fraction was 47.7 ± 7.8 with 3DE and 47.9 ± 6.7 with MRI, agreement between both methods was good (ICC = 0.72).
Conclusion: Three-dimensional echocardiography combined to semi-automated quantification software shows fair agreement with MRI for RV volumes and EF measurement in patients with repaired ToF and adequate intra- and interobserver variability. These results suggest applicability for serial follow-up of patients with right heart congenital disease. However, the accuracy of 3DE echo diminishes with larger RV volumes, in part due to current difficulty to include the entire RV in the imaged sector. Technical progress in transducers beam geometry is likely to address this issue.
Keywords: Right ventricle; Congenital; Fallot; Function; 3D echocardiography