Helbing W A, Bosch H G, Maliepaard C, Rebergen S A, van der Geest R J, Hansen B, Ottenkamp J, Reiber J H, de Roos A
Department of Pediatrics (Division of Pediatric Cardiology), Leiden University, The Netherlands.
Am J Cardiol. 1995 Sep 15;76(8):589-94. doi: 10.1016/s0002-9149(99)80161-1.
Assessment of right ventricular (RV) function is clinically relevant in the follow-up of various forms of congenital heart disease. Agreement on the value of different echocardiographic approaches for this purpose is lacking. Magnetic resonance imaging (MRI) provides dimensionally accurate RV volumes and ejection fraction. Transthoracic 2-dimensional echocardiography from 3 different views and gradient-echo tomographic MRI were performed in 16 children with congenital heart disease and 17 age-matched healthy children. RV volumes and ejection fraction were calculated with 5 mono- and biplane area-length and multiple-slice echocardiographic methods. Adequate MRI and echocardiographic apical 4-chamber images could be obtained in all 33 children. The best correlation between MRI and echocardiographic volumes was with the biplane pyramidal approximation method. End-diastolic volume by MRI was 92 +/- 27 ml: systematic difference with echocardiography was +14 +/- 16 ml (r = 0.86). End-systolic volume by MRI was 33 +/- 13 ml: systematic difference with echocardiography was -4 +/- 7 ml (r = 0.82). Ejection fraction by MRI was 65 +/- 8%: systematic difference with echocardiography was +5 +/- 7% (r = 0.72), using monoplane ellipsoid approximation. For all echocardiographic methods, significant effects of RV geometry were noted. Echocardiographic mono- and biplane area-length and multiple-slice calculations demonstrated moderate correlation and significant systematic errors compared with MRI-derived RV volumes. Echocardiographic results were influenced by RV geometry. The relatively simple monoplane area-length method provides ejection fraction results acceptable for clinical practice; results are not improved by more complex biplane and/or multislice methods.
评估右心室（RV）功能在各种先天性心脏病的随访中具有临床意义。目前对于为此目的采用不同超声心动图方法的价值尚未达成共识。磁共振成像（MRI）可提供尺寸精确的右心室容积和射血分数。对16例先天性心脏病患儿和17例年龄匹配的健康儿童进行了来自3个不同视图的经胸二维超声心动图检查以及梯度回波断层MRI检查。采用5种单平面和双平面面积长度法及多层超声心动图方法计算右心室容积和射血分数。所有33名儿童均获得了足够的MRI和超声心动图心尖四腔心图像。MRI与超声心动图容积之间的最佳相关性是双平面锥体近似法。MRI测得的舒张末期容积为92±27ml：与超声心动图的系统差异为+14±16ml（r = 0.86）。MRI测得的收缩末期容积为33±13ml：与超声心动图的系统差异为-4±7ml（r = 0.82）。采用单平面椭圆近似法时，MRI测得的射血分数为65±8%：与超声心动图的系统差异为+5±7%（r = 0.72）。对于所有超声心动图方法，均注意到右心室几何形状的显著影响。与MRI得出的右心室容积相比，超声心动图单平面和双平面面积长度法及多层计算显示出中等相关性和显著的系统误差。超声心动图结果受右心室几何形状影响。相对简单的单平面面积长度法提供的射血分数结果在临床实践中是可接受的；更复杂的双平面和/或多层方法并未改善结果。
