Abstract
BackgroundThree-dimensional echocardiography (3DE) and semi-automatic right ventricular delineation has been proposed as an appropriate method for right ventricle (RV) evaluation. We aimed to examine how manual correction of semi-automatic delineation influences the accuracy of 3DE for RV volumes and function in a clinical adult setting using cardiac magnetic resonance (CMR) as the reference method. We also examined the feasibility of RV visualization with 3DE.Methods62 non-selected patients were examined with 3DE (Sonos 7500 and iE33) and with CMR (1.5T). Endocardial RV contours of 3DE-images were semi-automatically assessed and manually corrected in all patients. End-diastolic (EDV), end-systolic (ESV) volumes, stroke volume (SV) and ejection fraction (EF) were computed.Results53 patients (85%) had 3DE-images feasible for examination. Correlation coefficients and Bland Altman biases between 3DE with manual correction and CMR were r = 0.78, -22 ± 27 mL for EDV, r = 0.83, -7 ± 16 mL for ESV, r = 0.60, -12 ± 18 mL for SV and r = 0.60, -2 ± 8% for EF (p < 0.001 for all r-values). Without manual correction r-values were 0.77, 0.77, 0.70 and 0.49 for EDV, ESV, SV and EF, respectively (p < 0.001 for all r-values) and biases were larger for EDV, SV and EF (-32 ± 26 mL, -21 ± 15 mL and - 6 ± 9%, p ≤ 0.01 for all) compared to manual correction.ConclusionManual correction of the 3DE semi-automatic RV delineation decreases the bias and is needed for acceptable clinical accuracy. 3DE is highly feasible for visualizing the RV in an adult clinical setting.
Highlights
Assessment of the right ventricular volumes and function is of great importance in the diagnosis of various heart diseases e.g. pulmonary hypertension and congenital heart disease [1,2,3], for the choice of therapeutical strategies [4] and not least of prognostic value [5,6,7].Two-dimensional echocardiography (2DE) is the most commonly used clinical imaging modality in the evaluation of the right ventricle (RV)
The patients with clinically indicated echocardiography were examined with an additional research related cardiac magnetic resonance (CMR), and patients with clinically indicated CMR were examined with an extra echocardiographic examination
This study has shown that manual correction of the semi-automated 3-dimensional echocardiography (3DE) of the RV is needed as the bias increases without manual correction
Summary
Assessment of the right ventricular volumes and function is of great importance in the diagnosis of various heart diseases e.g. pulmonary hypertension and congenital heart disease [1,2,3], for the choice of therapeutical strategies [4] and not least of prognostic value [5,6,7].Two-dimensional echocardiography (2DE) is the most commonly used clinical imaging modality in the evaluation of the right ventricle (RV). Adult patients with acquired heart disease were recently evaluated with the semi-automatic dedicated 3DE algorithm [23,24]. Some investigators have manually corrected the semi-automatic delineation in all patients [23], some not at all [18] and some if considered necessary [24]. It is not clear if manual correction is needed for clinical use of 3DE. Three-dimensional echocardiography (3DE) and semi-automatic right ventricular delineation has been proposed as an appropriate method for right ventricle (RV) evaluation. We aimed to examine how manual correction of semi-automatic delineation influences the accuracy of 3DE for RV volumes and function in a clinical adult setting using cardiac magnetic resonance (CMR) as the reference method. We examined the feasibility of RV visualization with 3DE
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