Feasibility and reproducibility of three-dimensional echocardiographic assessment of right ventricular size and function in pediatric patients.
BACKGROUND
Quantitative assessment of right ventricular (RV) size and function is important in congenital heart disease. Although three-dimensional (3D) echocardiography overcomes geometric challenges that limit two-dimensional echocardiography, its feasibility and reproducibility in children have not been systematically evaluated. The goal of this study was to determine the feasibility and reproducibility of 3D echocardiographic RV measurements in children.


METHODS
Patients aged 0 to 20 years were prospectively enrolled. Full-volume 3D echocardiographic RV data sets were acquired in each from the subxiphoid and apical four-chamber views by a trained sonographer. Another sonographer then acquired a second image data set from the same patient. RV volumes and ejection fraction were then measured offline. Outcomes included successful acquisition, measurable data set, and observer and interstudy variability.


RESULTS
Three-dimensional echocardiographic RV data sets were obtainable in 67 of 70 patients (96%) and were measurable from at least one view in 39 (58%). Factors associated with nonmeasurable data sets by univariate analysis included older age, larger body surface area and body mass index, no sedation, and female gender. Multivariate analysis identified older age (odds ratio, 1.34; 95% confidence interval, 1.17-1.55, P < .0001) and female gender (odds ratio, 6.06; 95% confidence interval, 1.45-25.3, P = .0135) as independently associated with nonmeasurable RV data sets. Intraobserver, interobserver, and interstudy agreement was excellent for analyzable RV volumes and modest for RV ejection fraction.


CONCLUSIONS
Transthoracic 3D echocardiographic RV volumes were measurable in 58% of children with and without congenital heart disease. Older age and female gender were independently associated with nonanalyzable data sets. When feasible, measurements of RV volumes are highly reproducible.
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Pierangelo
P
Renella
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Gerald R
GR
Marx
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Jing
J
Zhou
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Kimberlee
K
Gauvreau
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. Electronic address: tal.geva@cardio.chboston.org.
Tal
T
Geva
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D016278:Ventricular Function, Right / Q000502:physiology*; D055815:Young Adult
Congenital heart disease; Heart defects; Pediatrics; Right ventricle; Three-dimensional echocardiography