Feasibility and Accuracy of a Fully Automated Right Ventricular Quantification Software With Three-Dimensional Echocardiography: Comparison With Cardiac Magnetic Resonance.

Ashfaq Ahmad,Yi Zhong,Yanting Zhang,He Li,Luyang Yi,Ying Gao,Yixia Lin,Xiaojing Wan,Juanjuan Liu,Mingzhu Qian,Li Zhang,Yuman Li,Mingxing Xie

doi:10.3389/fcvm.2021.732893

Abstract

Background: A novel, fully automated right ventricular (RV) software for three-dimensional quantification of RV volumes and function was developed. The direct comparison of the software performance with cardiac magnetic resonance (CMR) was limited. Therefore, the aim of this study was to test the feasibility, accuracy, and reproducibility of a fully automated RV quantification software against CMR imaging as a reference.Methods: A total of 170 patients who underwent both CMR and three-dimensional echocardiography were enrolled. RV end-diastolic volume (RVEDV), RV end-systolic volume (RVESV), and RV ejection fraction (RVEF) were obtained using fully automated three-dimensional RV quantification software and compared with a CMR reference. For inter-technical agreement, Spearman correlation and Bland–Altman analysis were used.Results: The fully automated RV quantification software was feasible in 149 patients. RVEDV and RVESV were underestimated, and RVEF was overestimated compared with CMR values. RV measurements obtained from the manual editing method correlated better with CMR values than that without manual editing (RVEDV, 0.924 vs. 0.794: RVESV, 0.955 vs. 0.854; RVEF, 0.941 vs. 0.781 respectively, all p < 0.0001) with less bias and narrower limit of agreement (LOA). The bias and LOA for RV volumes and EF using the automated software without and with manual editing were greater in patients with severely impaired RV function or low frame rate than those with normal and mild impaired RV function, or high frame rate. The fully automated RV three-dimensional measurements were highly reproducible.Conclusion: The novel fully automated RV software shows good feasibility and reproducibility, and the measurements had a high correlation with CMR values. These findings support the routine application of the novel 3D automated RV software in clinical practice.

Highlights

Right ventricular (RV) function has been demonstrated to be independently associated with poor clinical outcomes in patients with a variety of cardiac and pulmonary pathologies [1, 2]
RV measurements obtained from the manual editing method correlated better with cardiac magnetic resonance (CMR) values than that without manual editing (RVEDV, 0.924 vs. 0.794: RV end-systolic volume (RVESV), 0.955 vs. 0.854; RV ejection fraction (RVEF), 0.941 vs. 0.781, respectively, all p < 0.0001)
The main findings of the present study can be summarized as (i) RV volumes and function using fully automated RV quantification software were strongly correlated with CMR values. (ii) The manual editing method improved measurement accuracy. (iii) The bias and limit of agreement (LOA) for the RV volumes and EF using the 3D auto RV software were smaller in patients with normal or mild impaired RV function or frame rate (FR) >23 frame/s than those with severely impaired RV function or FR ≤23 frame/s regardless of whether the manual editing was performed. (iv) The fully automated software showed excellent reproducibility and reduced the duration of analysis

Summary

Introduction

Right ventricular (RV) function has been demonstrated to be independently associated with poor clinical outcomes in patients with a variety of cardiac and pulmonary pathologies [1, 2]. Numerous studies have demonstrated the accuracy of 3DE for RV measurements in comparison with CMR reference [7,8,9,10] and have confirmed its incremental prognostic value over conventional 2DE indices [11,12,13]. Despite these aforementioned advantages, widespread application of 3DE for RV assessments has not been incorporated into the clinical practice. A novel, fully automated right ventricular (RV) software for three-dimensional quantification of RV volumes and function was developed. The aim of this study was to test the feasibility, accuracy, and reproducibility of a fully automated RV quantification software against CMR imaging as a reference

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Results

Discussion

Conclusion