Right ventricular ejection fraction measurements using two-dimensional transthoracic echocardiography by applying an
Stina Jorstig1,2, Micael Waldenborg3,4, Mats Lidén3,5
1School of Medical Sciences, Faculty of Medicine and Health, Örebro University, 70182, Örebro, Sweden. stina.jorstig@regionorebrolan.se.
Background:
There is today no established approach to estimate right ventricular ejection fraction (RVEF) using 2D transthoracic echocardiography (TTE). The aim of this study was to evaluate a new method for RVEF calculations using 2D TTE and compare the results with cardiac magnetic resonance (CMR) imaging and tricuspid annular plane systolic excursion (TAPSE).
Methods:
A total of 37 subjects, 25 retrospectively included patients and twelve healthy volunteers, were included to give a wide range of RVEF. The right ventricle (RV) was modeled as a part of an ellipsoid enabling calculation of the RV volume by combining three distance measurements. RVEF calculated according to the model, RVEFTTE, were compared with reference CMR-derived RVEF, RVEFCMR. Further, TAPSE was measured in the TTE images and the correlations were calculated between RVEFTTE, TAPSE and RVEFCMR.
Results:
The mean values were RVEFCMR = 43 ± 12% (range 20-66%) and RVEFTTE = 50 ± 9% (range 34-65%). There was a high correlation (r = 0.80, p < 0.001) between RVEFTTE and RVEFCMR. Bland-Altman analysis showed a mean difference between RVEFCMR and RVEFTTE of 6 percentage points (ppt) with limits of agreement from -11 to 23 ppt. The mean value for TAPSE was 19 ± 5 mm and the correlation between TAPSE and RVEFCMR was moderate (r = 0.54, p < 0.001). The correlation between RVEFTTE and RVEFCMR was significantly higher (p < 0.05) than the correlation between TAPSE and RVEFCMR.
Conclusions:
The ellipsoid model shows promise for RVEF calculations using 2D TTE for a wide range of RVEF, providing RVEF estimates that were significantly better correlated to RVEF obtained from CMR compared to TAPSE.
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