title: 3D Echo systematically underestimates right ventricular volumes compared to cardiovascular magnetic resonance in adult congenital heart disease patients with moderate or severe RV dilatation.
abstract: BACKGROUND
  Three dimensional echo is a relatively new technique which may offer a rapid alternative for the examination of the right heart. However its role in patients with non-standard ventricular size or anatomy is unclear. This study compared volumetric measurements of the right ventricle in 25 patients with adult congenital heart disease using both cardiovascular magnetic resonance (CMR) and three dimensional echocardiography.
  
  
  METHODS
  Patients were grouped by diagnosis into those expected to have normal or near-normal RV size (patients with repaired coarctation of the aorta) and patients expected to have moderate or worse RV enlargement (patients with repaired tetralogy of Fallot or transposition of the great arteries). Right ventricular end diastolic volume, end systolic volume and ejection fraction were compared using both methods with CMR regarded as the reference standard
  
  
  RESULTS
  Bland-Altman analysis of the 25 patients demonstrated that for both RV EDV and RV ESV, there was a significant and systematic under-estimation of volume by 3D echo compared to CMR. This bias led to a mean underestimation of RV EDV by -34% (95%CI: -91% to + 23%). The degree of underestimation was more marked for RV ESV with a bias of -42% (95%CI: -117% to + 32%). There was also a tendency to overestimate RV EF by 3D echo with a bias of approximately 13% (95% CI -52% to +27%).
  
  
  CONCLUSIONS
  Statistically significant and clinically meaningful differences in volumetric measurements were observed between the two techniques. Three dimensional echocardiography does not appear ready for routine clinical use in RV assessment in congenital heart disease patients with more than mild RV dilatation at the current time.
authors.affiliation: Division of Medicine (Cardiology), Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada. andrew.crean@uhn.on.ca
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Crean
authors.forename: Neil
authors.initials: N
authors.lastname: Maredia
authors.forename: George
authors.initials: G
authors.lastname: Ballard
authors.forename: Ravi
authors.initials: R
authors.lastname: Menezes
authors.forename: Gill
authors.initials: G
authors.lastname: Wharton
authors.forename: Jan
authors.initials: J
authors.lastname: Forster
authors.forename: John P
authors.initials: JP
authors.lastname: Greenwood
authors.forename: John D
authors.initials: JD
authors.lastname: Thomson
mesh_terms: D000328:Adult; D004108:Dilatation, Pathologic; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D055815:Young Adult