Skip to main content
SpringerLink
Log in

Semi-automated echocardiographic quantification of right ventricular size and function

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Although parameters of right ventricular (RV) size and function are clinically important, echocardiographic assessment of this chamber is complex. Existing quantitative approaches rely on manual measurements performed on different images, and are thus time-consuming. Consequently, in clinical practice, qualitative assessment is usually used instead. We tested a new approach for automated measurements of RV size and function using speckle tracking by comparing them to the conventional manual methodology. Transthoracic images were obtained in 149 patients with a wide range of RV size and function, and were analyzed by an expert using conventional techniques to obtain RV end-diastolic and end-systolic areas, fractional area change, dimensions (basal and mid-cavity diameters and length), tricuspid annular plane systolic excursion and peak systolic velocity. Same parameters were obtained using the semi-automated software (Epsilon Imaging), which requires tracing of the RV endocardial boundary in a single frame in the RV focused view. Fifteen patients were excluded due to image quality (90 % feasibility). Time required for the automated analysis was approximately 30 s per patient, compared to 4 min for conventional analysis. The parameters obtained with the semi-automated approach were in good agreement with manual measurements: r-values 0.79–0.95 for RV size and 0.70–0.74 for function indices and biases of 2–22 % of the mean measured values, which were comparable to the intrinsic variability of the conventional technique. In conclusion, the semi-automated technique is feasible, fast and provides quantitative parameters of RV size and function, which are comparable to conventional measurements.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

References

  1. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K et al (2010) 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 23:685–713 quiz 86-8

    Article  PubMed  Google Scholar 

  2. Saguner AM, Vecchiati A, Baldinger SH, Rueger S, Medeiros-Domingo A, Mueller-Burri AS et al (2014) Different prognostic value of functional right ventricular parameters in arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circ Cardiovasc Imaging 7:230–239

    Article  PubMed  Google Scholar 

  3. Cohen S, Gaddam S, Gemignani A, Wu WC, Sharma S, Choudhary G (2013) Right ventricular function relates to functional capacity in men with atrial fibrillation and preserved left ventricular ejection fraction. Echocardiography 30:542–550

    Article  PubMed  Google Scholar 

  4. Leong DP, Hoke U, Delgado V, Auger D, Witkowski T, Thijssen J et al (2013) Right ventricular function and survival following cardiac resynchronisation therapy. Heart 99:722–728

    Article  PubMed  Google Scholar 

  5. Poliacikova P, Cockburn J, Pareek N, James R, Lee L, Trivedi U et al (2013) Prognostic impact of pre-existing right ventricular dysfunction on the outcome of transcatheter aortic valve implantation. J Invasive Cardiol 25:142–145

    PubMed  Google Scholar 

  6. Damy T, Ghio S, Rigby AS, Hittinger L, Jacobs S, Leyva F et al (2013) Interplay between right ventricular function and cardiac resynchronization therapy: an analysis of the CARE-HF trial (Cardiac Resynchronization-Heart Failure). J Am Coll Cardiol 61:2153–2160

    Article  PubMed  Google Scholar 

  7. Guazzi M, Bandera F, Pelissero G, Castelvecchio S, Menicanti L, Ghio S et al (2013) 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 305:H1373–H1381

    Article  CAS  PubMed  Google Scholar 

  8. Finocchiaro G, Knowles JW, Pavlovic A, Perez M, Magavern E, Sinagra G et al (2014) Prevalence and clinical correlates of right ventricular dysfunction in patients with hypertrophic cardiomyopathy. Am J Cardiol 113:361–367

    Article  PubMed  Google Scholar 

  9. Pruszczyk P, Goliszek S, Lichodziejewska B, Kostrubiec M, Ciurzynski M, Kurnicka K et al (2014) Prognostic value of echocardiography in normotensive patients with acute pulmonary embolism. JACC Cardiovasc Imaging 7:553–560

    Article  PubMed  Google Scholar 

  10. Perez JE, Waggoner AD, Barzilai B, Melton HE Jr, Miller JG, Sobel BE (1992) On-line assessment of ventricular function by automatic boundary detection and ultrasonic backscatter imaging. J Am Coll Cardiol 19:313–320

    Article  CAS  PubMed  Google Scholar 

  11. Michalis LK, Thomas MR, Jewitt DE, Monaghan MJ (1995) Echocardiographic assessment of systolic and diastolic left ventricular function using an automatic boundary detection system. Correlation with established invasive and non invasive parameters. Int J Card Imaging 11:71–80

    Article  CAS  PubMed  Google Scholar 

  12. Sapin PM, Kwan OL, Xie GY, Smith MD, DeMaria AN (1995) The assessment of left ventricular filling dynamics using an online automatic border detection algorithm: comparison with cineventriculography. Echocardiography 12:559–569

    Article  CAS  PubMed  Google Scholar 

  13. Yagi T, Yoshida K, Hozumi T, Akasaka T, Takagi T, Yamamuro A et al (1996) Automatic assessment of left ventricular cavity area by the automated contour tracking method. J Cardiol 28:345–348

    CAS  PubMed  Google Scholar 

  14. Iwase M, Kondo T, Hasegawa K, Kimura M, Matsuyama H, Watanabe Y et al (1997) Three-dimensional echocardiography by semi-automatic border detection in assessment of left ventricular volume and ejection fraction: comparison with magnetic resonance imaging. J Cardiol 30:97–105

    CAS  PubMed  Google Scholar 

  15. Tighe DA, Paul JJ, Pohl CA, Cook JR, Huhta JC (1998) Automatic border detection for assessment of left ventricular diastolic function among normal neonates: comparison with doppler echocardiography. Echocardiography 15:545–552

    Article  PubMed  Google Scholar 

  16. Jacobs LD, Salgo IS, Goonewardena S, Weinert L, Coon P, Bardo D et al (2006) Rapid online quantification of left ventricular volume from real-time three-dimensional echocardiographic data. Eur Heart J 27:460–468

    Article  PubMed  Google Scholar 

  17. Kirkpatrick JN, Lang RM, Fedson SE, Anderson AS, Bednarz J, Spencer KT (2005) Automated border detection on contrast enhanced echocardiographic images. Int J Cardiol 103:164–167

    Article  PubMed  Google Scholar 

  18. Mele D, Teoli R, Cittanti C, Pasanisi G, Guardigli G, Levine RA et al (2004) Assessment of left ventricular volume and function by integration of simplified 3D echocardiography, tissue harmonic imaging and automated extraction of endocardial borders. Int J Cardiovasc Imaging 20:191–202

    Article  PubMed  Google Scholar 

  19. Rahmouni HW, Ky B, Plappert T, Duffy K, Wiegers SE, Ferrari VA et al (2008) Clinical utility of automated assessment of left ventricular ejection fraction using artificial intelligence-assisted border detection. Am Heart J 155:562–570

    Article  PubMed  Google Scholar 

  20. Sugioka K, Hozumi T, Watanabe H, Yamagishi H, Matsumura Y, Takemoto Y et al (2003) Rapid and accurate noninvasive assessment of global left ventricular systolic function using biplane advanced automated contour tracking method. J Am Soc Echocardiogr 16:1237–1243

    Article  PubMed  Google Scholar 

  21. Sugioka K, Hozumi T, Yagi T, Yamamuro A, Akasaka T, Takeuchi K et al (2003) Automated quantification of left ventricular function by the automated contour tracking method. Echocardiography 20:313–318

    Article  PubMed  Google Scholar 

  22. Rein AJ, Tracey M, Colan SD, Pollak A, Sanders SP (1998) Automated left ventricular endocardial border detection using acoustic quantification in children. Echocardiography 15:111–120

    Article  PubMed  Google Scholar 

  23. Kanzaki Y, Yoshida K, Hozumi T, Akasaka T, Takagi T, Yonezawa Y et al (1999) Measurement of left ventricular filling by automated contour tracking method in echocardiography: comparison with radionuclide ventriculography. J Cardiol 34:207–210

    CAS  PubMed  Google Scholar 

  24. Grandi AM, Bignotti M, Bertolini A, Gaudio G, Zanzi P, Guasti L et al (1997) Clinical feasibility of echocardiographic automated border detection in monitoring left ventricular response to acute changes of preload in normal subjects. Cardiology 88:393–396

    Article  CAS  PubMed  Google Scholar 

  25. Mor-Avi V, Gillesberg IE, Korcarz C, Sandelski J, Lang RM (1995) Improved quantification of left ventricular function by applying signal averaging to echocardiographic acoustic quantification. J Am Soc Echocardiogr 8:679–689

    Article  CAS  PubMed  Google Scholar 

  26. Morrissey RL, Siu SC, Guerrero JL, Newell JB, Weyman AE, Picard MH (1994) Automated assessment of ventricular volume and function by echocardiography: validation of automated border detection. J Am Soc Echocardiogr 7:107–115

    Article  CAS  PubMed  Google Scholar 

  27. Oe M, Gorcsan J 3rd, Mandarino WA, Kawai A, Griffith BP, Kormos RL (1995) Automated echocardiographic measures of right ventricular area as an index of volume and end-systolic pressure-area relations to assess right ventricular function. Circulation 92:1026–1033

    Article  CAS  PubMed  Google Scholar 

  28. Forni G, Pozzoli M, Cannizzaro G, Traversi E, Calsamiglia G, Rossi D et al (1996) Assessment of right ventricular function in patients with congestive heart failure by echocardiographic automated boundary detection. Am J Cardiol 78:1317–1321

    Article  CAS  PubMed  Google Scholar 

  29. Helbing WA, Bosch HG, Maliepaard C, Zwinderman KH, Rebergen SA, Ottenkamp J et al (1997) On-line automated border detection for echocardiographic quantification of right ventricular size and function in children. Pediatr Cardiol 18:261–269

    Article  CAS  PubMed  Google Scholar 

  30. Greiner S, Andre F, Heimisch M, Hess A, Steen H, Katus HA et al (2013) Non-invasive quantification of right ventricular systolic function by echocardiography: a new semi-automated approach. Clin Res Cardiol 102:229–235

    Article  PubMed  Google Scholar 

  31. Chang WT, Tsai WC, Liu YW, Lee CH, Liu PY, Chen JY et al (2014) Changes in right ventricular free wall strain in patients with coronary artery disease involving the right coronary artery. J Am Soc Echocardiogr 27:230–238

    Article  PubMed  Google Scholar 

  32. Marston N, Brown JP, Olson N, Auger WR, Madani MM, Wong D, et al (2014) Right ventricular strain before and after pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension. Echocardiography. doi:10.1111/echo.12812

  33. Motoki H, Borowski AG, Shrestha K, Hu B, Kusunose K, Troughton RW et al (2014) Right ventricular global longitudinal strain provides prognostic value incremental to left ventricular ejection fraction in patients with heart failure. J Am Soc Echocardiogr 27:726–732

    Article  PubMed  Google Scholar 

  34. Naderi N, Ojaghi Haghighi Z, Amin A, Naghashzadeh F, Bakhshandeh H, Taghavi S et al (2013) Utility of right ventricular strain imaging in predicting pulmonary vascular resistance in patients with pulmonary hypertension. Congest Heart Fail 19:116–122

    Article  PubMed  Google Scholar 

  35. Okumura K, Humpl T, Dragulescu A, Mertens L, Friedberg MK (2014) Longitudinal assessment of right ventricular myocardial strain in relation to transplant-free survival in children with idiopathic pulmonary hypertension. J Am Soc Echocardiogr 27:1344–1351

  36. Platz E, Hassanein AH, Shah A, Goldhaber SZ, Solomon SD (2012) Regional right ventricular strain pattern in patients with acute pulmonary embolism. Echocardiography 29:464–470

    Article  PubMed  Google Scholar 

  37. Rajagopal S, Forsha DE, Risum N, Hornik CP, Poms AD, Fortin TA et al (2014) Comprehensive assessment of right ventricular function in patients with pulmonary hypertension with global longitudinal peak systolic strain derived from multiple right ventricular views. J Am Soc Echocardiogr 27(657–65):e3

    PubMed  Google Scholar 

  38. Ternacle J, Berry M, Cognet T, Kloeckner M, Damy T, Monin JL et al (2013) Prognostic value of right ventricular two-dimensional global strain in patients referred for cardiac surgery. J Am Soc Echocardiogr 26:721–726

    Article  PubMed  Google Scholar 

  39. Fine NM, Chen L, Bastiansen PM, Frantz RP, Pellikka PA, Oh JK, et al (2015) Reference values for right ventricular strain in patients without cardiopulmonary disease: a prospective evaluation and meta-analysis. Echocardiography 32:787–796

  40. Shiota T, Jones M, Chikada M, Fleishman CE, Castellucci JB, Cotter B et al (1998) Real-time three-dimensional echocardiography for determining right ventricular stroke volume in an animal model of chronic right ventricular volume overload. Circulation 97:1897–1900

    Article  CAS  PubMed  Google Scholar 

  41. Niemann PS, Pinho L, Balbach T, Galuschky C, Blankenhagen M, Silberbach M et al (2007) Anatomically oriented right ventricular volume measurements with dynamic three-dimensional echocardiography validated by 3-Tesla magnetic resonance imaging. J Am Coll Cardiol 50:1668–1676

    Article  PubMed  Google Scholar 

  42. D’Andrea A, Riegler L, Morra S, Scarafile R, Salerno G, Cocchia R et al (2012) Right ventricular morphology and function in top-level athletes: a three-dimensional echocardiographic study. J Am Soc Echocardiogr 25:1268–1276

    Article  PubMed  Google Scholar 

  43. Maffessanti F, Muraru D, Esposito R, Gripari P, Ermacora D, Santoro C et al (2013) Age-, body size-, and sex-specific reference values for right ventricular volumes and ejection fraction by three-dimensional echocardiography: a multicenter echocardiographic study in 507 healthy volunteers. Circ Cardiovasc Imaging 6:700–710

    Article  PubMed  Google Scholar 

  44. Zhang QB, Sun JP, Gao RF, Lee AP, Feng YL, Liu XR et al (2013) Feasibility of single-beat full-volume capture real-time three-dimensional echocardiography for quantification of right ventricular volume: validation by cardiac magnetic resonance imaging. Int J Cardiol 168:3991–3995

    Article  PubMed  Google Scholar 

  45. Renella P, Marx GR, Zhou J, Gauvreau K, Geva T (2014) Feasibility and reproducibility of three-dimensional echocardiographic assessment of right ventricular size and function in pediatric patients. J Am Soc Echocardiogr 27:903–910

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by an equipment grant from Epsilon Imaging, who provided computer hardware and software.

Conflict of interest

Jamie Hamilton is a full-time employee of Epsilon Imaging. None of the other authors have any potential conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, MC5084, Chicago, IL, 60637, USA

    Diego Medvedofsky, Karima Addetia, Roberto M. Lang & Victor Mor-Avi

  2. Epsilon Imaging, Ann Arbor, MI, USA

    Jamie Hamilton

  3. Jerez de la Frontera Hospital, Cádiz, Spain

    Javier Leon Jimenez

Authors
  1. Diego Medvedofsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karima Addetia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jamie Hamilton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Javier Leon Jimenez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberto M. Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Victor Mor-Avi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Victor Mor-Avi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Medvedofsky, D., Addetia, K., Hamilton, J. et al. Semi-automated echocardiographic quantification of right ventricular size and function. Int J Cardiovasc Imaging 31, 1149–1157 (2015). https://doi.org/10.1007/s10554-015-0672-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-015-0672-4

Keywords

Search

Navigation