Right ventricular ejection fraction measurements using two-dimensional transthoracic echocardiography by applying an ellipsoid model

Stina Jorstig, Micael Waldenborg, Mats Lidén, Per Thunberg, Stina Jorstig, Micael Waldenborg, Mats Lidén, Per Thunberg

Abstract

Background: There is today no established approach to estimate right ventricular ejection fraction (RVEF) using 2D transthoracic echocardiography (TTE). The aim of this study was to evaluate a new method for RVEF calculations using 2D TTE and compare the results with cardiac magnetic resonance (CMR) imaging and tricuspid annular plane systolic excursion (TAPSE).

Methods: A total of 37 subjects, 25 retrospectively included patients and twelve healthy volunteers, were included to give a wide range of RVEF. The right ventricle (RV) was modeled as a part of an ellipsoid enabling calculation of the RV volume by combining three distance measurements. RVEF calculated according to the model, RVEFTTE, were compared with reference CMR-derived RVEF, RVEFCMR. Further, TAPSE was measured in the TTE images and the correlations were calculated between RVEFTTE, TAPSE and RVEFCMR.

Results: The mean values were RVEFCMR = 43 ± 12% (range 20-66%) and RVEFTTE = 50 ± 9% (range 34-65%). There was a high correlation (r = 0.80, p < 0.001) between RVEFTTE and RVEFCMR. Bland-Altman analysis showed a mean difference between RVEFCMR and RVEFTTE of 6 percentage points (ppt) with limits of agreement from -11 to 23 ppt. The mean value for TAPSE was 19 ± 5 mm and the correlation between TAPSE and RVEFCMR was moderate (r = 0.54, p < 0.001). The correlation between RVEFTTE and RVEFCMR was significantly higher (p < 0.05) than the correlation between TAPSE and RVEFCMR.

Conclusions: The ellipsoid model shows promise for RVEF calculations using 2D TTE for a wide range of RVEF, providing RVEF estimates that were significantly better correlated to RVEF obtained from CMR compared to TAPSE.

Keywords: Cardiac magnetic resonance imaging; Echocardiography; Right ventricle; Right ventricular function.

Figures

Fig. 1
Fig. 1
Transthoracic echocardiography distances. Images showing the transthoracic echocardiography distances for a healthy 33 year old male subject in a) and b) apical 4CH view and in c) apical 2CH view. LA = left atrium, LV = left ventricle, LVD = left ventricular diameter, RA = right atrium, RV = right ventricle, RVIT3 = right ventricular inflow tract, RVLAX = right ventricular long axis
Fig. 2
Fig. 2
Correlation between RVEFCMR, RVEFTTE and TAPSE. The correlation between a) RVEF obtained from the application of the ellipsoid model using TTE measurements and RVEF derived from CMR imaging and b) the correlation between TAPSE from TTE and RVEF derived from CMR. CMR = cardiac magnetic resonance, RVEF = right ventricular ejection fraction, TAPSE = tricuspid annular plane systolic excursion, TTE = transthoracic echocardiography
Fig. 3
Fig. 3
Bland-Altman plot of agreement between RVEFTTE and RVEFCMR. Bland-Altman plot of the agreement between the mean values for RVEF calculated using the ellipsoid model on TTE measurements and RVEF derived from CMR. The dashed lines show the mean value and the limits of agreements. CMR = cardiac magnetic resonance, RVEF = right ventricular ejection fraction, TTE = transthoracic echocardiography
Fig. 4
Fig. 4
Ellipsoid model. Parts of two ellipsoids with different sizes but two of three radiuses in common

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