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Updated: Sep 24, 2025
Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
Published on: October 28, 2020
Three-Dimensional Echocardiography Right Ventricular Volumes and Ejection Fraction Reference Values in Children: A
Pei-Ni Jone1, Lisa Le1, Zhaoxing Pan2
1Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA.
Insights
This study provides sex-specific reference values and z-score equations for pediatric right ventricular (RV) volumes and ejection fraction (EF) using three-dimensional echocardiography (3DE). These data aid in the serial assessment and management of children
Area of Science:
- Pediatric cardiology
- Medical imaging
- Echocardiography
Background:
- Three-dimensional echocardiography (3DE) is crucial for assessing right ventricular (RV) function in children.
- Existing reference values for RV parameters lack sex-specific details, hindering precise clinical management.
- North American multi-center data are needed to establish robust pediatric RV reference values.
Purpose of the Study:
- To generate sex-specific reference values and z-score equations for pediatric RV volumetric parameters.
- To establish equations independent of age and body size indices.
- To facilitate clinical utility in serial assessments and management of pediatric cardiac conditions.
Main Methods:
- Prospective recruitment of 455 healthy children (0-18 years) across 5 centers.
- Acquisition of RV 3DE using various vendors, analyzed with vendor-independent software.
- Generation of z-scores for RV end-systolic volume (ESV), end-diastolic volume (EDV), and stroke volume (SV), with sex-based comparisons.
Main Results:
- 312 (68%) of 3DE datasets met analysis criteria.
- Reported mean and standard deviation for RV EDV, ESV, and SV for both male and female patients.
- Developed a downloadable z-score calculator using height and weight; sex differences in RV ejection fraction (RVEF) were clinically insignificant after adjustment.
Conclusions:
- Established sex-specific reference values for pediatric RV volumes and EF from 3DE data.
- Derived z-score equations applicable across multiple North American centers.
- The findings support improved accuracy in pediatric RV assessment and management.
Background:
Three-dimensional echocardiography (3DE) evaluation of right ventricular (RV) volumes and ejection fraction (EF) is increasingly used for clinical serial assessments and management in children. This study aims to generate sex-specific reference values and z-score equations for RV volumetric parameters, independent of age and body size indices, derived from multiple populations across North America.
Methods:
We prospectively recruited 455 healthy children (ages 0 to 18 years) from 5 centres. 3DE of the RV were acquired using various vendors with analyses performed offline using vendor-independent software. 3DE datasets with all walls of the RV endocardium visible were included. We reported data on RV EF, and generated z scores for end-systolic volumes (ESV), end-diastolic volumes (EDV) and stroke volume (SV). Differences between the sexes were explored.
Results:
Of 455 3DE datasets, 312 (68%) met imaging criteria for analysis. Median age was 10.1 years (interquartile ratio [IQR]: 5.6, 14.0) with 17% being younger than 3 years of age. The mean and standard deviation for RV EDV, ESV, and SV for male and female patients were reported. We provided a downloadable z-score calculator with height and weight as independent variables to facilitate clinical utility. Although statistically significant differences between male and female RVEF was present (female 52.9 ± 3.9% vs male 51.6 ± 3.5%, P = 0.006), after adjusting for age, height, and weight, the magnitude of difference was clinically insignificant.
Conclusions:
Sex-specific reference values for pediatric RV volumes and EF, and z-score equations were derived from children 3DE datasets across 5 centres in North America.
