Background

Functional assessment of the right ventricle using real-time three-dimensional echocardiography (RT3DE) has fundamental relevance in young patients with congenital heart disease. Reference values for the pediatric population are scarce. This multicenter study was designed to (1) validate new evaluation software for RT3DE and (2) establish pediatric reference values.

Methods

For validation, right ventricular (RV) end-diastolic volume (EDV) and end-systolic volume (ESV) were determined from real-time three-dimensional echocardiographic data sets of 38 subjects (n = 17 healthy individuals and n = 21 patients with congenital heart disease) using new dedicated evaluation software (RV-Function 2.0) and compared with cardiac magnetic resonance investigations of the same patient cohort. In a prospective multicenter design, 360 real-time three-dimensional echocardiographic data sets of healthy children (172 girls) were analyzed. To create reference centiles, the cohort was subdivided into group I (children <7 years of age, n = 136 [female and male]), group II (girls 7–18 years of age, n = 106), and group III (boys 7–18 years of age, n = 118).

Results

Using RT3DE, RV volumes were slightly higher than using cardiac magnetic resonance (EDV, 0.8 ± 5.8% [limits of agreement, −10.8% to 12.5%; r = 0.993]; ESV, 2.0 ± 13.1% [limits of agreement, −24.2% to 28.2%; r = 0.989). Reproducibility was promising (intraobserver variability, 3.9 ± 11.4% for EDV and −1.7 ± 13.4% for ESV [intraclass correlation coefficient range, 0.94–0.98]; interobserver variability, 1.9 ± 11.8% for EDV and −0.3 ± 22.8% for ESV [intraclass correlation coefficient range, 0.85–0.96]). Regarding functional parameters, no significant gender differences were found among children in group I. In contrast, children in groups II and III differed in RV volumes, dimensional parameters, and tricuspid annular plane systolic excursion (P < .005); the children did not differ in deformation parameters. Feasibility was 90%.

Conclusions

RT3DE yields accurate and reproducible RV volumes. The calculated percentile curves may facilitate the clinical use of RT3DE to analyze RV function in children.

中文翻译：

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儿童三维超声心动图右心室容积的验证和参考价值：一项多中心研究

背景

在年轻的先天性心脏病患者中，使用实时三维超声心动图（RT3DE）对右心室进行功能评估具有根本意义。儿科人群的参考值很少。这项多中心研究旨在（1）验证用于RT3DE的新评估软件，以及（2）建立儿科参考值。

方法

为了进行验证，从38位受试者的实时三维超声心动图数据集中确定了右心室（RV）的舒张末期容积（EDV）和收缩末期容积（ESV）（n  = 17名健康个体，n  = 21名患者先天性心脏病）使用新的专用评估软件（RV-Function 2.0），并与同一患者队列的心脏磁共振检查进行了比较。在前瞻性多中心设计中，分析了健康儿童（172个女孩）的360个实时三维超声心动图数据集。为了创建参考分位数，将队列分为I组（7岁以下的儿童，n  = 136 [男女]），II组（7-18岁的女孩，n） = 106）和第三组（7-18岁的男孩，n  = 118）。

结果

使用RT3DE，RV体积略高于使用心脏磁共振（EDV，0.8±5.8％[一致极限，-10.8％至12.5％；r  = 0.993]； ESV，2.0±13.1％[一致极限，-24.2 ％至28.2％；r  = 0.989）。可重复性是有希望的（观察者内变异性，对于EDV为3.9±11.4％，对于ESV为−1.7±13.4％[类内相关系数范围，0.94-0.98]；观察者间变异性，对于EDV为1.9±11.8％，对于ESV为-0.3±22.8％[组内相关系数范围，0.85–0.96]。在功能参数方面，第一组儿童之间没有发现明显的性别差异。相反，第二和第三组儿童的右室容量，尺寸参数和三尖瓣环平面收缩期偏移（P <.005）; 孩子们的变形参数没有差异。可行性为90％。

结论

RT3DE可产生准确且可重复的RV量。计算出的百分位数曲线可能有助于RT3DE在临床上分析儿童RV功能的临床应用。