Abstract
Until now, right atrial (RA) volume calculation by means of two-dimensional echocardiography (2-DE) has only been attempted in a single plane: the apical four-chamber view. Our study reports a new method for RA volume calculation using two intersecting 2-DE views. For this purpose, silicone rubber casts of 19 human necropsy hearts were obtained and thin-walled natural rubber moulds of the RA casts were prepared. Totally filled with and immersed in water, the moulds could be visualized in the apical four-chamber view and an additional 2-DE plane, the latter corresponding to the subcostal view in vivo. In this view the vertical extension of RA could be estimated. Areas and lengths of RA were determined in the respective planes, and RA volume was calculated by applying the formula, area x length, to two intersecting planes. Finally, volume of the silicone casts was determined angiocardiographically (Angio) using a biplane method (30° RAO, 40° LAO-40° hepatoclavicular). The true RA volume was 106±23 ml (mean±1SD) as determined by water displacement. Using Angio an excellent correlation was found: the calculated volume amounted to 106±23ml; the difference was 5.5±4.8ml (n.s.); Angio vol=0.93 true vol+ 7.77; r=0.95; SEE= 7,4 ml. Volume determination from the apical four-chamber view of 2-DE using a monoplane disk method resulted in a mean volume of 62±17 ml. The mean difference to the true RA volume was 44±16 ml (p < 0.001). When volume calculations were made using the biplane method, a value of 105±22 ml resulted. The mean difference to true volumes was 7.4±4.8 ml: y=0.84x + 15.88; r=0.91; SEE=9.4 ml.
In an in vivo study endsystolic RA volumes were calculated in a normal adult population (n=40) from the same intersecting planes as in vitro. A normal value of 38±6 ml/m2 was found. In vivo validation using Angio showed a slightly higher normal value of 43=7 ml/m2. Thus, 2-DE is highly accurate in determinating RA volume. In the in vitro as well as in the in vivo study the results of monoplane calculations are clearly inferior to a method which also takes account of the vertical extension of RA.
Similar content being viewed by others
References
Graham TP, Atwood GF, Faulkner SL, Nelson JH. Right atrial volume measurements from biplane cineangiography. Methodology, normal values, and alterations with pressure or volume overload. Circulation 1974; 49: 709–16.
Lambertz H, Braun C, Krebs W. Größenbestimmung des rechten Vorhofes mittels zweidimensionaler Echokardiographie. Z Kardiol 1984; 73: 393–8.
Heiliger R, Richter HA, Krebs W, Braun C, Lambertz H, Mittermayer C. Volumebestimmung des rechten Vorhofes mittels Ausgußtechnik zur Quantifizierung der zweidimensionalen Echokardiographie am Modell und Präparat. Biomed Tech 1984; 29E: 67–8.
Wang Y, Heibron D, Gutman J, Wahr D, Schiller NB. Clinical quantitative echocardiography: I. End systolic atrial volume in a normal adult population. Am J Cardiol 1982; 49: 905.
Reeves DC, Hallahan W, Schwiter EJ, Ciotoly TJ, Buonocore E, Davidson W. Two-dimensional echocardiographic assessment of electrocardiographic criteria for right atrial enlargement. Circulation 1981; 64: 387–91.
Olsen EGJ. The pathology of the heart. The Macmillan Press L.T.D. second edition, London and Basingstoke, 1980.
Lambertz H, Heiliger R. Visualization of superior vena cava by two-dimensional echocardiography. Am Heart J 1985; 109: 1401–2.
Tajik AJ, Seward JB, Hagler DJ, Ritter DG. Two-dimensional real-time ultrasonic imaging of the heart and great vessels. Mayo Clin Proc 1978; 53: 271–303.
Bargeron LM Jr, Elliot LP, Soto B. Axial cineangiography in congenital heart disease: section I, concept, technical and anatomical considerations. Circulation 1977; 56: 1075–83.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 307–10.
Haendchen RV, Povzhitkov M, Meerbaum S, Maurer G, Corday E. Evaluation of changes in left ventricular enddiastolic pressure by left atrial two-dimensional echocardiography. Am Heart J 1982; 104: 740–5.
Lambertz H, Krebs W, Soeding S, Wohltmann D, Sechtem U, Kemmer HP. Größenbestimmung des rechten Vorhofes bei Patienten mit pulmonaler Hypertonie mittels zweidimensionaler Echokardiographie. Z Kardiol 1984; 73: 646–53.
Arvidsson H. Angiocardiographic determination of left ventricular volume. Acta Radiol 1961; 56: 321–39.
Chapman CB, Baker O, Reynolds J, Bonte FJ. Use of biplane cinefluorography for measurement of ventricular volume. Circulation 1958; 43: 1105–17.
Davila JC, Sanmarco ME. An analysis of the fit of mathematical models applicable to the measurement of ventricular volume. Am J Cardiol 1966; 18: 31–42.
Eaton LW, Maughan WL, Shoukas AA, Weiss JL. Accurate volume determination in the isolated ejecting canine left ventricle by two-dimensional echocardiography. Circulation 1979; 60: 320–6.
Wyatt HL, Heng MK, Meerbaum S, Gueret P, Dual E, Corday E. Cross-sectional echocardiography. II. Analysis of mathematical models for quantifying volume of the formaline-fixed left ventricle. Circulation 1980; 61: 1119–25.
Erbel R. Funktionsdiagnostik des linken Ventrikels mittels zweidimensonaler Echokardiographie. Steinkopff Verlag, Darmstadt 1983.
Levine RA, Gibson TC, Aretz T, Gillam LD, Guyer DE, King ME, Weyman AE. Echocardiographic measurements of right ventricular volume Circulatinn 1984; 69: 497–505
Erbel R, Krebs W, Massberg I, Schweizer P, Richter HA, Meyer J, Effert S. New method for right ventricular volume determination by two-dimensional echocardiography. Proc Computers in Cardiology 53–6, 1984 IEEE Computer society catalogue '83 CH 1927–3.
Toma Y, Matsuda Y, Matsuzaki M, Anno Y, Uchida T, Hiroyama H, Tamitani M, Murata T, Yonezawa F, Moritani K, Katayama K, Ogawa H, Kusukawa R. Determination of atrial size by esophageal echocardiography. Am J Cardiol 1983; 52: 878–80.
Bommer W, Weinert L, Neumann A, Neef J, Mason DT, DeMaria A. Determination of right atrial and right ventricular size by two-dimensional echocardiography. Circulation 1979; 60: 91.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lambertz, H., Flachskampf, F.A., Heiliger, R. et al. New echocardiographic and angiographic methods for right atrial volume determination: In vitro validation and in vivo results. Int J Cardiac Imag 5, 39–51 (1989). https://doi.org/10.1007/BF01745231
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01745231