Pressure overloaded right ventricles: importance of trabeculae in evaluation of RV function by CMR

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Background Cardiac magnetic resonance imaging (CMR) is the preferred method to evaluate right ventricular (RV) volumes and ejection fraction. In CMR-volumetry, trabeculae and papillary muscles can be either in- or excluded from the blood volume and both methods are used throughout literature. This study aimed to determine the impact of trabeculae and papillary muscles on right ventricular (RV) volumes and function assessed by CMR in different patient groups with pressure overloaded RVs using semi-automatic software and to determine the reproducibility of this method. Methods Four groups of 20 patients (pulmonary hypertension, arterial switch operation (ASO), Tetralogy of Fallot (TOF), systemic RV) and 20 healthy subjects underwent shortaxis multislice cine CMR. End diastolic volume (EDV), end systolic volume (ESV), RV mass and ejection fraction (EF) were measured using 2 methods. First, only manual contour tracing of the endo and epicardial borders was performed thus including trabeculae in the blood volume (method 1). With method 2, trabeculae were excluded from the blood volume using semi-automatic pixel-intensity based software. Differences in EDV, ESV volumes, RVEF and RV mass after excluding trabeculae were tested using paired samples T-test. For intra- and interobserver agreement 25 datasets were re-analyzed.