title: Assessment of right ventricular function by real-time three-dimensional echocardiography improves accuracy and decreases interobserver variability compared with conventional two-dimensional views.
abstract: OBJECTIVE
  Two-dimensional echocardiographic (2DE) assessment of right ventricular (RV) function is difficult, often resulting in inconsistent RV evaluation. Real-time three-dimensional echocardiography (RT3DE) allows the RV to be viewed in multiple planes, which can potentially improve RV assessment and limit interobserver variability when compared with 2DE.
  
  
  RESULTS
  Twenty-five patients underwent 2DE and RT3DE. Views of 2DE (RV inflow, RV short axis, and apical four-chamber) were compared with RT3DE views by four readers. RT3DE data sets were sliced from anterior-posterior (apical view) and from base to apex (short axis) to obtain six standardized planes. Readers recorded the RV ejection fraction (RVEF) from 2DE and RT3DE images. RVEF recorded by RT3DE (RVEF(3D)) and 2D (RVEF(2D)) were compared with RVEF by disc summation (RVEF(DS)), which was used as a reference. Interobserver variability among readers of RVEF(3D) and RVEF(2D) was then compared. Overall, mean RVEF(DS), RVEF(3D), and RVEF(2D) were 37 +/- 11%, 38 +/- 10%, 41 +/- 10%, respectively. The mean difference of RVEF(3D)-RVEF(DS) was significantly less than RVEF(2D)-RVEF(DS) (3.7 +/- 4% vs. 7.1 +/- 5%, P = 0.0066, F-test). RVEF(3D) correlated better with RVEF(DS) (r = 0.875 vs. r = 0.69, P = 0.028, t-test). RVEF(3D) was associated with a 39% decrease in interobserver variability when compared with RVEF(2D) [standard deviation of mean difference: 3.7 vs. 5.1, (RT3DE vs. 2DE), P = 0.018, t-test].
  
  
  CONCLUSIONS
  RT3DE provides improved accuracy of RV function assessment and decreases interobserver variability when compared with 2D views.
authors.affiliation: Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, VBK 508, Boston, MA 02114, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Chua
authors.forename: Robert A
authors.initials: RA
authors.lastname: Levine
authors.forename: Chaim
authors.initials: C
authors.lastname: Yosefy
authors.forename: Mark D
authors.initials: MD
authors.lastname: Handschumacher
authors.forename: John
authors.initials: J
authors.lastname: Chu
authors.forename: Anwer
authors.initials: A
authors.lastname: Qureshi
authors.forename: Jennifer
authors.initials: J
authors.lastname: Neary
authors.forename: Thanh-Thao
authors.initials: TT
authors.lastname: Ton-Nu
authors.forename: Morgan
authors.initials: M
authors.lastname: Fu
authors.forename: Chiung Jen
authors.initials: CJ
authors.lastname: Wu
authors.forename: Judy
authors.initials: J
authors.lastname: Hung
mesh_terms: D019560:Echocardiography, Three-Dimensional; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D016278:Ventricular Function, Right