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High-echoic line tracing of transthoracic echocardiography accurately assesses right ventricular enlargement in adult patients with atrial septal defect

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Abstract

Accurate measurement of right ventricular (RV) size using transthoracic echocardiography (TTE) is important for evaluating the severity of congenital heart diseases. The RV end-diastolic area index (RVEDAi) determined using TTE is used to assess RV dilatation; however, the tracing line of the RVEDAi has not been clearly defined by the guidelines. This study aimed to determine the exact tracing method for RVEDAi using TTE. We retrospectively studied 107 patients with atrial septal defects who underwent cardiac magnetic resonance imaging (CMR) and TTE. We measured the RVEDAi according to isoechoic and high-echoic lines, and compared it with the RVEDAi measured using CMR. The isoechoic line was defined as the isoechoic endocardial border of the RV free wall, whereas the high-echoic line was defined as the high-echoic endocardial border of the RV free wall more outside than the isoechoic line. RVEDAi measured using high-echoic line (high-RVEDAi) was more accurately related to RVEDAi measured using CMR than that measured using isoechoic line (iso-RVEDAi). The difference in the high-RVEDAi was 0.3 cm2/m2, and the limit of agreement (LOA) was − 3.7 to 4.3 cm2/m2. With regard to inter-observer variability, high-RVEDAi was superior to iso-RVEDAi. High-RVEDAi had greater agreement with CMR-RVEDAi than with iso-RVEDAi. High-RVEDAi can become the standard measurement of RV size using two-dimensional TTE.

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Acknowledgements

This study was supported by a “medical stuff research grant” from the Japanese Circulation Society. We acknowledge the support of the staff of the Heart Center of Kyushu University Hospital (Fukuoka, Japan), especially to Goro Kawahara, Tokiko Koya, Asami Hanada, Yuya Fukudome, Ryoko Hayashi, Miki Kawamura, Manami Ito, and Takuto Moriyama, who acquired the TTE images and data. We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan

    Tasuku Sato & Min-Jeong Kang

  2. Heart Center, Kyushu University Hospital, Fukuoka, Japan

    Tasuku Sato

  3. Department of Cardiovascular Medicine, School of Medical Sciences, Kyushu University Graduate, Kyushu University, Fukuoka, Japan

    Ichiro Sakamoto, Ken-ichi Hiasa, Ayako Ishikita, Shintaro Umemoto & Hiroyuki Tsutsui

  4. Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan

    Masateru Kawakubo & Hiroshi Shigeto

  5. Department of Health Care for Adults, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Hiroyuki Sawatari

  6. Health Care Center, Fukuoka Dental College Hospital, Fukuoka, Japan

    Akiko Chishaki

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  1. Tasuku Sato
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Contributions

TS, IS, MK, H Sawatari, and AC designed this study. TS, IS, MK, KMJ, H Sawatari, and AC preformed the data acquisition and statistical analysis. TS and IS wrote the manuscript and KH, AI, SU, AC, H Sigeto, and HT revised and commented. All authors approved the final manuscript.

Corresponding author

Correspondence to Tasuku Sato.

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Conflict of interest

Tasuku Sato, Ichiro Sakamoto, Masateru Kawakubo, Ayako Ishikita, Shintaro Umemoto, Min-Jeong Kang, Hiroyuki Sawatari, Akiko Chishaki, and Hiroshi Shigeto, declare that there are no conflicts of interest. Ken-ichi Hiasa received remuneration from Daiichi Sankyo, Nippon Boehringer Ingelheim, Pfizer, Bristol-Myers Squibb, Bayer, and Otsuka Pharmaceutical. Hiroyuki Tsutusi received remuneration from Kowa, Teijin Pharma, Nippon Boehringer, Ingelheim, Mitsubishi Tanabe Pharma, Pfizer Japan, Ono Pharmaceutical, Daiichi Sankyo, Novartis Pharma, Bayer Yakuhin, Otsuka Pharmaceutical, and AstraZeneca; manuscript fees from Nippon Rinsho; research funding from Abbott Medical Japan, Otsuka Pharmaceutical, Boston Scientific Japan, Ono Pharmaceutical, Bayer Yakuhin, Nippon Boehringer Ingelheim, St.Mary’s Hospital, Teijin Pharma, Daiichi Sankyo, and Mitsubishi Tanabe Pharma; and donations Abbott Medical Japan, Otsuka Pharmaceutical, Boston Scientific Japan, Ono Pharmaceutical, Bayer Yakuhin, Nippon Boehringer Ingelheim, St.Mary's Hospital, Teijin Pharma, Daiichi Sankyo, and Mitsubishi Tanabe Pharma. Hiroyuki Tsutsui is a member of Circulation Journal’s editorial team.

Ethical approval

The study protocol was approved by the Ethics Committee of Kyushu University Hospital (Approval number: 2020–39), and the study complied with the 1964 Declaration of Helsinki and its later amendments. Kyusyu University (Tasuku Sato, Ichiro Sakamoto, Ken-ichi Hiasa, Ayako Ishikita, Shintaro Umemoto, Min-Jeong Kang, and Hiroyuki Tsutsui), Fukuoka, Japan; Kyushu University Graduate School of Medical Sciences (Masateru Kawakubo and Hiroshi Shigeto), Fukuoka, Japan; Hiroshima University (Hiroyuki Sawatari), Hiroshima, Japan; Fukuoka Dental College Hospital (Akiko Chishaki), Fukuoka, Japan.

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Sato, T., Sakamoto, I., Hiasa, Ki. et al. High-echoic line tracing of transthoracic echocardiography accurately assesses right ventricular enlargement in adult patients with atrial septal defect. Int J Cardiovasc Imaging 39, 87–95 (2023). https://doi.org/10.1007/s10554-022-02712-x

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