Relationship between echocardiographic and magnetic resonance derived measures of right ventricular size and function in patients with pulmonary hypertension.
BACKGROUND
Transthoracic echocardiographic (TTE) imaging is the mainstay of clinical practice for evaluating right ventricular (RV) size and function, but its accuracy in patients with pulmonary hypertension has not been well validated.


METHODS
Magnetic resonance imaging (MRI) and TTE images were retrospectively reviewed in 40 consecutive patients with pulmonary hypertension. RV and left ventricular volumes and ejection fractions were calculated using MRI. TTE areas and indices of RV ejection fraction (RVEF) were compared.


RESULTS
The average age was 42 ± 12 years, with a majority of women (85%). There was a wide range of mean pulmonary arterial pressures (27-81 mm Hg) and RV end-diastolic volumes (111-576 mL), RVEFs (8%-67 %), and left ventricular ejection fractions (26%-72%) by MRI. There was a strong association between TTE and MRI-derived parameters: RV end-diastolic area (by TTE imaging) and RV end-diastolic volume (by MRI), R(2) = 0.78 (P < .001); RV fractional area change by TTE imaging and RVEF by MRI, R(2) = 0.76 (P < .001); and tricuspid annular plane systolic excursion by TTE imaging and RVEF by MRI, R(2) = 0.64 (P < .001). By receiver operating characteristic curve analysis, an RV fractional area change < 25% provided excellent discrimination of moderate systolic dysfunction (RVEF < 35%), with an area under the curve of 0.97 (P < .001). An RV end-diastolic area index of 18 cm(2)/m(2) provided excellent discrimination for moderate RV enlargement (area under the curve, 0.89; P < .001).


CONCLUSIONS
Echocardiographic estimates of RV volume (by RV end-diastolic area) and function (by RV fractional area change and tricuspid annular plane systolic excursion) offer good approximations of RV size and function in patients with pulmonary hypertension and allow the accurate discrimination of normal from abnormal.
Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California. Electronic address: hshiran@stanford.edu.
Hadas
H
Shiran
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, California; Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford School of Medicine, Stanford, California.
Roham T
RT
Zamanian
Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California; Stanford Cardiovascular Institute, Stanford School of Medicine, Stanford, California.
Michael V
MV
McConnell
Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California.
David H
DH
Liang
Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California.
Rajesh
R
Dash
Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California.
Shahriar
S
Heidary
Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
Naga Lakshmi
NL
Sudini
Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California.
Joseph C
JC
Wu
Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California.
Francois
F
Haddad
Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California.
Phillip C
PC
Yang
D000328:Adult; D000368:Aged; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000175:diagnosis*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000209:etiology*
Echocardiography; MRI; Pulmonary hypertension; Right ventricle