Amsallem Myriam, Lu HongQuan, Tang Xiu, Do Couto Francisco Nadia L, Kobayashi Yukari, Moneghetti Kegan, Shiran Hadas, Rogers Ian, Schnittger Ingela, Liang David, Haddad François
Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
Int J Cardiovasc Imaging. 2018 Sep;34(9):1409-1417. doi: 10.1007/s10554-018-1356-7. Epub 2018 Apr 13.
Obtaining focused right ventricular (RV) apical view remains challenging using conventional two-dimensional (2D) echocardiography. This study main objective was to determine whether measurements from RV focused views derived from three-dimensional (3D) echocardiography (3D-RV-focused) are closely related to measurements from magnetic resonance (CMR). A first cohort of 47 patients underwent 3D echocardiography and CMR imaging within 2 h of each other. A second cohort of 25 patients had repeat 3D echocardiography to determine the test-retest characteristics; and evaluate the bias associated with unfocused RV views. Tomographic views were extracted from the 3D dataset: RV focused views were obtained using the maximal RV diameter in the transverse plane, and unfocused views from a smaller transverse diameter enabling visualization of the tricuspid valve opening. Measures derived using the 3D-RV-focused view were strongly associated with CMR measurements. Among functional metrics, the strongest association was between RV fractional area change (RVFAC) and ejection fraction (RVEF) (r = 0.92) while tricuspid annular plane systolic excursion moderately correlated with RVEF (r = 0.47), all p < 0.001. Among RV size measures, the strongest association was found between RV end-systolic area (RVESA) and volume (r = 0.87, p < 0.001). RV unfocused views led on average to 10% underestimation of RVESA. The 3D-RV-focused method had acceptable test-retest characteristics with a coefficient of variation of 10% for RVESA and 11% for RVFAC. Deriving standardized RV focused views using 3D echocardiography strongly relates to CMR-derived measures and may improve reproducibility in RV 2D measurements.
使用传统二维超声心动图获取聚焦的右心室（RV）心尖视图仍然具有挑战性。本研究的主要目的是确定三维超声心动图（3D-RV聚焦）获得的RV聚焦视图测量值是否与磁共振（CMR）测量值密切相关。第一组47例患者在彼此2小时内接受了3D超声心动图和CMR成像。第二组25例患者进行了重复3D超声心动图检查，以确定重测特征；并评估与未聚焦RV视图相关的偏差。从3D数据集中提取断层图像：使用横切面上最大的RV直径获得RV聚焦视图，从不太宽的横径获得未聚焦视图，以便能看到三尖瓣开口。使用3D-RV聚焦视图得出的测量值与CMR测量值密切相关。在功能指标中，最强的关联是右心室面积变化分数（RVFAC）与射血分数（RVEF）之间（r = 0.92），而三尖瓣环平面收缩期位移与RVEF中度相关（r = 0.47），所有p < 0.001。在RV大小测量中，最强的关联是在右心室收缩末期面积（RVESA）与容积之间（r = 0.87，p < 0.001）。未聚焦的RV视图平均导致RVESA低估10%。3D-RV聚焦方法具有可接受的重测特征，RVESA的变异系数为10%，RVFAC的变异系数为11%。使用3D超声心动图得出标准化的RV聚焦视图与CMR得出的测量值密切相关，可能会提高RV二维测量的可重复性。
