Three-Dimensional Echocardiography for Evaluation of the Right Ventricle—Updates on Image Acquisition and Analysis
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Purpose of Review
Review three-dimensional echocardiographic (3DE) acquisition and analysis of the right ventricular (RV) chamber, the recommended technique by the American Society of Echocardiography guidelines.
3DE acquisition and analysis of RV size and function is available in the majority of clinical echocardiographic laboratories. Recent publications showed this approach provides accurate information despite the challenging chamber anatomy and physiology, when compared to magnetic resonance imaging as reference. 3DE assessment directly measures RV volumes without geometric assumptions. Accordingly, 3DE analysis was found more accurate and reproducible than conventional 2DE methodology, which measures only surrogate parameters of RV function.
RV 3DE assessment is ready for routine clinical use and has direct implications for patient management. 3DE evaluation has the potential to expand the analysis not only to traditionally parameters of size and function, but to new indices including shape, which may become a new useful diagnostic and prognostic information.
KeywordsRight ventricle Acquisition and analysis Right ventricular volumes and function Three-dimensional echocardiography Contrast agents
Compliance with Ethical Standards
There are no issues related to this article that could be construed as a violation of ethical standards.
Conflict of Interest
Eric Kruse reports personal fees from Lantheus Medical Imaging outside of the submitted work. Roberto Lang reports grants from Philips and TOMTEC, outside of the submitted work. The other authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
2DE RV focused 4-chamber view. From a 2DE apical conventional 4-chamber view, the RV focused 4-chamber view is obtained by modifying the position of the transducer more laterally, and its angle more anterior. (MP4 2917 kb)
Top: an example of a good quality 3D RV dataset without contrast (left), in which endocardial border definition further improved with contrast enhancement (right). Bottom: an example of a suboptimal quality 3D RV dataset, in which the endocardial border is poorly visualized without contrast (left), but was considerably improved by contrast enhancement (right), specially for the RV free wall anterior and lateral segments. (MP4 2208 kb)
Two right ventricular generated beating models with a fixed end-diastolic mesh, without (left) and with (right) a 2-dimensional background. (MP4 1360 kb)
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.Cohen MS, Jegatheeswaran A, Baffa JM, Gremmels DB, Overman DM, Caldarone CA, et al. Echocardiographic features defining right dominant unbalanced atrioventricular septal defect: a multi-institutional Congenital Heart Surgeons’ Society study. Circ Cardiovasc Imaging. 2013;6(4):508–13. https://doi.org/10.1161/CIRCIMAGING.112.000189.CrossRefPubMedGoogle Scholar
- 2.Cohen S, Gaddam S, Gemignani A, Wu WC, Sharma S, Choudhary G. Right ventricular function relates to functional capacity in men with atrial fibrillation and preserved left ventricular ejection fraction. Echocardiography. 2013;30(5):542–50. https://doi.org/10.1111/echo.12099.CrossRefPubMedGoogle Scholar
- 3.Damy T, Ghio S, Rigby AS, Hittinger L, Jacobs S, Leyva F, et al. Interplay between right ventricular function and cardiac resynchronization therapy: an analysis of the CARE-HF trial (Cardiac Resynchronization-Heart Failure). J Am Coll Cardiol. 2013;61(21):2153–60. https://doi.org/10.1016/j.jacc.2013.02.049. CrossRefPubMedGoogle Scholar
- 5.Guazzi M, Bandera F, Pelissero G, Castelvecchio S, Menicanti L, Ghio S, et al. Tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure relationship in heart failure: an index of right ventricular contractile function and prognosis. Am J Physiol Heart Circ Physiol. 2013;305(9):H1373–81. https://doi.org/10.1152/ajpheart.00157.2013.CrossRefPubMedGoogle Scholar
- 6.Hasan BS, Lunze FI, Chen MH, Brown DW, Boudreau MJ, Rhodes J, et al. Effects of transcatheter pulmonary valve replacement on the hemodynamic and ventricular response to exercise in patients with obstructed right ventricle-to-pulmonary artery conduits. JACC Cardiovasc Interv. 2014;7(5):530–42. https://doi.org/10.1016/j.jcin.2014.02.006.CrossRefPubMedGoogle Scholar
- 10.Saguner AM, Vecchiati A, Baldinger SH, Rueger S, Medeiros-Domingo A, Mueller-Burri AS, et al. Different prognostic value of functional right ventricular parameters in arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circ Cardiovasc Imaging. 2014;7(2):230–9. https://doi.org/10.1161/CIRCIMAGING.113.000210.CrossRefPubMedGoogle Scholar
- 13.Schuuring MJ, van Riel AC, Vis JC, Duffels MG, van Dijk AP, de Bruin-Bon RH, et al. New predictors of mortality in adults with congenital heart disease and pulmonary hypertension: midterm outcome of a prospective study. Int J Cardiol. 2015;181:270–6. https://doi.org/10.1016/j.ijcard.2014.11.222.CrossRefPubMedGoogle Scholar
- 14.Wald RM, Altaha MA, Alvarez N, Caldarone CA, Cavalle-Garrido T, Dallaire F, et al. Rationale and design of the Canadian Outcomes Registry Late After Tetralogy of Fallot Repair: the CORRELATE study. Can J Cardiol. 2014;30(11):1436–43. https://doi.org/10.1016/j.cjca.2014.06.011.CrossRefPubMedGoogle Scholar
- 16.• Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685–713; quiz 86–8. doi: https://doi.org/10.1016/j.echo.2010.05.010. Right ventricular echocardiographic guidelines.
- 17.• Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1–39 e14. https://doi.org/10.1016/j.echo.2014.10.003. Updated cardiac chamber quantification guidelines. CrossRefPubMedGoogle Scholar
- 19.Ling LF, Obuchowski NA, Rodriguez L, Popovic Z, Kwon D, Marwick TH. Accuracy and interobserver concordance of echocardiographic assessment of right ventricular size and systolic function: a quality control exercise. J Am Soc Echocardiogr. 2012;25(7):709–13. https://doi.org/10.1016/j.echo.2012.03.018.CrossRefPubMedGoogle Scholar
- 21.Leibundgut G, Rohner A, Grize L, Bernheim A, Kessel-Schaefer A, Bremerich J, et al. Dynamic assessment of right ventricular volumes and function by real-time three-dimensional echocardiography: a comparison study with magnetic resonance imaging in 100 adult patients. J Am Soc Echocardiogr. 2010;23(2):116–26. https://doi.org/10.1016/j.echo.2009.11.016.CrossRefPubMedGoogle Scholar
- 22.Nesser HJ, Tkalec W, Patel AR, Masani ND, Niel J, Markt B, et al. Quantitation of right ventricular volumes and ejection fraction by three-dimensional echocardiography in patients: comparison with magnetic resonance imaging and radionuclide ventriculography. Echocardiography. 2006;23(8):666–80. https://doi.org/10.1111/j.1540-8175.2006.00286.x.CrossRefPubMedGoogle Scholar
- 23.Niemann PS, Pinho L, Balbach T, Galuschky C, Blankenhagen M, Silberbach M, et al. Anatomically oriented right ventricular volume measurements with dynamic three-dimensional echocardiography validated by 3-Tesla magnetic resonance imaging. J Am Coll Cardiol. 2007;50(17):1668–76. https://doi.org/10.1016/j.jacc.2007.07.031.CrossRefPubMedGoogle Scholar
- 25.van der Zwaan HB, Geleijnse ML, McGhie JS, Boersma E, Helbing WA, Meijboom FJ, et al. Right ventricular quantification in clinical practice: two-dimensional vs. three-dimensional echocardiography compared with cardiac magnetic resonance imaging. Eur J Echocardiogr. 2011;12(9):656–64. https://doi.org/10.1093/ejechocard/jer107.CrossRefPubMedGoogle Scholar
- 26.Tosoratti E, Badano LP, Gianfagna P, Baldassi M, Proclemer A, Capelli C, et al. Improved delineation of morphological features of arrhythmogenic right ventricular cardiomyopathy with the use of contrast-enhanced echocardiography. J Cardiovasc Med (Hagerstown). 2006;7(7):566–8. https://doi.org/10.2459/01.JCM.0000234777.03949.10.CrossRefGoogle Scholar
- 28.Kaminska M, Sobkowicz B, Sawicki R, Lewkowicz J, Tomaszuk-Kazberuk A, Glinska R, et al. Is real time contrast echocardiography useful for assessment of the right ventricular morphology, function, and perfusion? Echocardiography. 2015;32(7):1080–6. https://doi.org/10.1111/echo.12819.CrossRefPubMedGoogle Scholar
- 29.• Medvedofsky D, Mor-Avi V, Kruse E, Guile B, Ciszek B, Weinert L, et al. Quantification of right ventricular size and function from contrast-enhanced three-dimensional echocardiographic images. J Am Soc Echocardiogr. 2017;30(12):1193–202. https://doi.org/10.1016/j.echo.2017.08.003. Three-dimensional echocardiographic validation study using contrast anhancing agents. CrossRefPubMedGoogle Scholar
- 30.Kim J, Cohen SB, Atalay MK, Maslow AD, Poppas A. Quantitative assessment of right ventricular volumes and ejection fraction in patients with left ventricular systolic dysfunction by real time three-dimensional echocardiography versus cardiac magnetic resonance imaging. Echocardiography. 2015;32(5):805–12. https://doi.org/10.1111/echo.12715.CrossRefPubMedGoogle Scholar
- 31.Seguela PE, Hascoet S, Brierre G, Bongard V, Acar P. Feasibility of three-dimensional transthoracic echocardiography to evaluate right ventricular volumes in children and comparison to left ventricular values. Echocardiography. 2012;29(4):492–501. https://doi.org/10.1111/j.1540-8175.2011.01596.x.CrossRefPubMedGoogle Scholar
- 32•.. Medvedofsky D, Addetia K, Patel AR, Sedlmeier A, Baumann R, Mor-Avi V, et al. Novel approach to three-dimensional echocardiographic quantification of right ventricular volumes and function from focused views. J Am Soc Echocardiogr. 2015;28(10):1222–31. https://doi.org/10.1016/j.echo.2015.06.013. Three-dimensional echocardiographic validation study vs cardiac magnetic resonance imaging. CrossRefPubMedGoogle Scholar
- 33.• Muraru D, Spadotto V, Cecchetto A, Romeo G, Aruta P, Ermacora D, et al. New speckle-tracking algorithm for right ventricular volume analysis from three-dimensional echocardiographic data sets: validation with cardiac magnetic resonance and comparison with the previous analysis tool. Eur Heart J Cardiovasc Imaging. 2016;17(11):1279–89. https://doi.org/10.1093/ehjci/jev309. Three-dimensional echocardiographic validation study vs cardiac magnetic resonance imaging. CrossRefPubMedGoogle Scholar
- 35.Mor-Avi V, Jenkins C, Kuhl HP, Nesser HJ, Marwick T, Franke A, et al. Real-time 3-dimensional echocardiographic quantification of left ventricular volumes: multicenter study for validation with magnetic resonance imaging and investigation of sources of error. JACC Cardiovasc Imaging. 2008;1(4):413–23. https://doi.org/10.1016/j.jcmg.2008.02.009.CrossRefPubMedGoogle Scholar
- 36.Addetia K, Maffessanti F, Yamat M, Weinert L, Narang A, Freed BH, et al. Three-dimensional echocardiography-based analysis of right ventricular shape in pulmonary arterial hypertension. Eur Heart J Cardiovasc Imaging. 2016;17(5):564–75. https://doi.org/10.1093/ehjci/jev171.CrossRefPubMedGoogle Scholar
- 37.• Addetia K, Uriel N, Maffessanti F, Sayer G, Adatya S, Kim GH, et al. 3D morphological changes in LV and RV during LVAD ramp studies. JACC Cardiovasc Imaging. 2018;11(2 Pt 1):159–69. https://doi.org/10.1016/j.jcmg.2016.12.019. Three-dimensional echocardiographic shape analysis of the left and right ventricles in LVADs patients. CrossRefPubMedGoogle Scholar