Paediatric Cardiology, Evelina London Children's Hospital, 6th Floor, Evelina Children's Hospital, 1 Westminster Bridge Road, London SE1 7EH, UK.
Eur Heart J Cardiovasc Imaging. 2014 Mar;15(3):257-66. doi: 10.1093/ehjci/jet145. Epub 2013 Aug 14.
Accurate assessment of right ventricular (RV) volumes and function is important in patients with hypoplastic left heart syndrome (HLHS). We prospectively sought to determine the reproducibility of three-dimensional (3D) echocardiography and its agreement with cardiac magnetic resonance imaging (CMR) in HLHS.
Twenty-eight patients underwent CMR followed immediately by transthoracic 3D echocardiography under general anaesthesia. Semi-automated border detection software was used to determine echocardiographic RV volumes. Inter- and intra-observer variability, correlation and levels of agreement between techniques were determined. The median age was 0.37 years (0.18-9.28 years) and weight 6.24 kg (3.42-32.50 kg). Intra- and inter-observer variability was excellent for both techniques. Median (range) measurements for 3D echocardiography and CMR were; end-diastolic volume (EDV) 23.6 mL (6.5-63.2) and 30.6 mL (11.8-87.9), end-systolic volume (ESV) 12.6 mL (3.7-37.0) and 14.9 mL (5.8-33.9), stroke volume (SV) 11.2 mL (2.8-33.0) and 17.1 mL (6.0-54.1), ejection fraction (EF) 48.2% (31.2-64.9), and 56.5% (42.7-72.2). Correlation coefficients were r = 0.85, 0.84, 0.83, and 0.74, respectively (P < 0.01 for all). Volumetric data were expressed as a percentage of the echocardiographic volume to CMR volume. When compared with CMR, 3D echocardiography underestimated EDV, ESV and SV by 26.7% (SD ± 20.2), 10.6% (±28.1), and 37.5% (±20.1), respectively. The difference in volume appeared largest at low ventricular volumes. EF was 8.3% (±7.3) lower by 3D echocardiography compared with CMR.
Both 3D echocardiography and CMR volumes appear highly reproducible. Measurements obtained by 3D echocardiography are significantly lower than those obtained by CMR, with wide limits of agreement such that these two methods cannot be used interchangeably.
准确评估右心室（RV）容积和功能对于左心发育不全综合征（HLHS）患者非常重要。我们前瞻性地研究了三维（3D）超声心动图在 HLHS 中的重复性及其与心脏磁共振成像（CMR）的一致性。
28 例患者在全身麻醉下接受 CMR 检查，随后立即进行经胸 3D 超声心动图检查。半自动边界检测软件用于确定超声心动图 RV 容积。确定了两种技术的观察者内和观察者间变异性、相关性和一致性水平。中位年龄为 0.37 岁（0.18-9.28 岁），体重 6.24 公斤（3.42-32.50 公斤）。两种技术的观察者内和观察者间变异性均良好。3D 超声心动图和 CMR 的中位（范围）测量值分别为：舒张末期容积（EDV）23.6 毫升（6.5-63.2）和 30.6 毫升（11.8-87.9），收缩末期容积（ESV）12.6 毫升（3.7-37.0）和 14.9 毫升（5.8-33.9），每搏输出量（SV）11.2 毫升（2.8-33.0）和 17.1 毫升（6.0-54.1），射血分数（EF）48.2%（31.2-64.9）和 56.5%（42.7-72.2）。相关系数分别为 r = 0.85、0.84、0.83 和 0.74（均 P < 0.01）。容积数据表示为超声心动图容积与 CMR 容积的百分比。与 CMR 相比，3D 超声心动图低估 EDV、ESV 和 SV 分别为 26.7%（SD ± 20.2）、10.6%（±28.1）和 37.5%（±20.1）。体积差异在心室体积较低时最大。3D 超声心动图的 EF 比 CMR 低 8.3%（±7.3）。
3D 超声心动图和 CMR 容积均具有高度可重复性。3D 超声心动图获得的测量值明显低于 CMR，且一致性范围较宽，因此这两种方法不能互换使用。
