Right ventricular remodelling in pulmonary arterial hypertension with three-dimensional echocardiography: comparison with cardiac magnetic resonance imaging.
OBJECTIVE
Right ventricular (RV) mass and volume calculations are important correlates of survival in patients with pulmonary arterial hypertension (PAH). We tested the hypothesis that RV mass, volumes and function could be measured accurately with real-time three-dimensional echocardiography (3DE) in patients with PAH and compared those against cardiac magnetic resonance (CMR).


RESULTS
Sixty consecutive PAH patients and 20 normals were examined with 3DE and CMR. RV end-diastolic volumes (EDV), end-systolic (ESV), stroke volume (SV), ejection fraction (EF), and mass were measured in all patients and in normals. Two independent observers assessed variability using the Bland-Altman analysis agreement. RV volumes (in mL) and mass were similar between 3DE and CMR in PAH patients: [EDV (in mL) 183.2 +/- 38 vs. 187.3 +/- 41, P = 0.32; ESV (in mL) 122 +/- 33 vs. 126 +/- 36, P = 0.99; SV (in mL) 63 +/- 15 vs. 65 +/- 19, P = 0.06; EF (in %) 33 +/- 7 vs. 31 +/- 9, P = 0.16 and RV mass (g) 99 +/- 20 vs. 96 +/- 22, P = 0.42], respectively. Interobserver variability was similar between 3DE and CMR in PAH for all variables, with CMR showing less interobserver variability for EDV compared with 3DE in both patients and normals (patients: mean bias: CMR-EDV: 0.4 +/- 16 mL vs. 3DE-EDV: 6.9 +/- 17.9 and in normals: CMR-EDV: 0.1 +/- 9.8 vs. 3DE-EDV: 5.7 +/- 16.3, respectively), whereas EF and RV mass were poorly reproducible with no correlation between observers for 3DE and CMR.


CONCLUSIONS
RV remodelling in PAH patients can be accurately assessed with both 3DE and CMR. Both modalities are robust and reproducible with CMR being more reproducible for measurements of EF and RV mass.
Grapsa
Julia
J
Department of Cardiovascular Sciences, Hammersmith Hospital, Imperial College London, NHLI, Du Cane Road, W12 0HS London, UK.
O'Regan
Declan P
DP
Pavlopoulos
Harry
H
Durighel
Giuliana
G
Dawson
David
D
Nihoyannopoulos
Petros
P
D000328:Adult; D016022:Case-Control Studies; D016001:Confidence Intervals; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D017380:Hypertrophy, Right Ventricular; D008279:Magnetic Resonance Imaging; D008297:Male; D013223:Statistics as Topic; D013318:Stroke Volume; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling