Utility of Three-Dimensional Echocardiography for Ventricular Assessment in Congenital Heart Disease: A Comparative...

Accurate quantification of ventricular volumes and function is critical for managing congenital heart disease (CHD) and guiding surgical and interventional decisions. Although cardiac magnetic resonance imaging (CMR) and cardiac catheterization (CA) are gold standards, their use is limited by availability, invasiveness, and patient tolerance. Three-dimensional echocardiography (3DE) offers a non-invasive alternative; however, validation across modalities in heterogeneous CHD populations is limited. The aim of this study was to evaluate the clinical utility of 3DE in patients with CHD by comparison with against measurements obtained by CMR and CA.

We retrospectively analyzed patients with CHD undergoing 3DE, CMR, and CA. Ventricular end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), and cardiac index (CI) were measured and compared across the three modalities. 3DE data were analyzed using Philips QLAB. Correlation coefficients, regression equations, and Bland-Altman analyses were used to assess agreement across modalities.

Thirty-six patients were included between 2024 and 2025. Strong correlations were observed between 3DE and CMR (LVEDV r = 0.94, RVEDV r = 0.93) as well as 3DE and CA (LVEDV r = 0.86, RVEDV r = 0.89). 3DE systematically underestimated volumes (3DE < CMR < CA). EF showed excellent correlation across modalities, whereas CI exhibited greater variability. Bland-Altman analysis confirmed a systematic bias that remained within clinically acceptable limits for population-level assessment, although individual-based variability should be considered.

3DE provides reliable volumetric and functional assessment in patients with CHD, with strong correlation with CMR and CA despite systematic underestimation of absolute values. 3DE is a practical noninvasive modality for serial follow-up.