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European Journal of Echocardiography Advance Access published online on March 2, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jep013
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Assessment of right ventricular function by real-time three-dimensional echocardiography improves accuracy and decreases interobserver variability compared with conventional two-dimensional views

Sarah Chua1,2, Robert A. Levine1, Chaim Yosefy1, Mark D. Handschumacher1, John Chu1, Anwer Qureshi1, Jennifer Neary1, Thanh-Thao Ton-Nu1, Morgan Fu2, Chiung Jen Wu2 and Judy Hung1,*

1 Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, VBK 508, Boston, MA 02114, USA
2 Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan, Republic of China

Received 11 July 2008; accepted after revision 24 January 2009.

* Corresponding author. Tel: +1 617 726 0995; fax: +1 617 726 8383. E-mail address: jhung{at}partners.org


  Abstract

Aims: Two-dimensional echocardiographic (2DE) assessment of right ventricular (RV) function is difficult, often resulting in inconsistent RV evaluation. Real-time three-dimensional echocardiography (RT3DE) allows the RV to be viewed in multiple planes, which can potentially improve RV assessment and limit interobserver variability when compared with 2DE.

Methods and results: Twenty-five patients underwent 2DE and RT3DE. Views of 2DE (RV inflow, RV short axis, and apical four-chamber) were compared with RT3DE views by four readers. RT3DE data sets were sliced from anterior–posterior (apical view) and from base to apex (short axis) to obtain six standardized planes. Readers recorded the RV ejection fraction (RVEF) from 2DE and RT3DE images. RVEF recorded by RT3DE (RVEF3D) and 2D (RVEF2D) were compared with RVEF by disc summation (RVEFDS), which was used as a reference. Interobserver variability among readers of RVEF3D and RVEF2D was then compared. Overall, mean RVEFDS, RVEF3D, and RVEF2D were 37 ± 11%, 38 ± 10%, 41 ± 10%, respectively. The mean difference of RVEF3D – RVEFDS was significantly less than RVEF2D–RVEFDS (3.7 ± 4% vs. 7.1 ± 5%, P = 0.0066, F-test). RVEF3D correlated better with RVEFDS (r = 0.875 vs. r = 0.69, P = 0.028, t-test). RVEF3D was associated with a 39% decrease in interobserver variability when compared with RVEF2D [standard deviation of mean difference: 3.7 vs. 5.1, (RT3DE vs. 2DE), P = 0.018, t-test].

Conclusions: RT3DE provides improved accuracy of RV function assessment and decreases interobserver variability when compared with 2D views.

Keywords: Right ventricle function; Three-dimensional echocardiography


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