Abstract 14386: Can 2-Dimensional Echocardiography Provide Accurate Assessments of Right Ventricular Volume and Systolic Function in Patients With Pulmonary Hypertension?
Background: Right ventricular (RV) morphology and systolic function are major determinants of survival in patients with pulmonary arterial hypertension (PAH). However, quantitation is problematic when algorithms developed for the left ventricle are extrapolated to the RV, because of differences in ventricular geometry. Real-time 3-dimensional echocardiography (RT3DE) offers RV quantitation independent of assumptions about RV shape, and has been extensively validated, but is technically complex and time-consuming.
Hypothesis: RV assessments based on 2-D echo (2DE) are unreliable in patients with known or suspected PAH, when RT3DE is used as the reference standard.
Methods: 31 pts (age 55.3 ± 12.6 (x ± SD) 61% women) with clinically suspected PAH underwent transthoracic 2DE and RT3DE evaluation of right ventricular size and systolic function. Analysis of 2DE included both subjective and quantitative measures of RV size and fractional area change. RT3DEs were analyzed offline using software specifically designed for that purpose (TomTecR).
Results: Twenty-three patients had RV enlargement and 23 patients had decreased RV ejection fraction (EF) by RT3DE. Sensitivity of subjective 2DE was only 57% and 48% for detection of abnormal RV size and systolic function, respectively. Specificities were 100% and 75%, respectively. Quantitative 2DE, using American Society of Echocardiography guidelines, provided only marginal improvement in diagnostic accuracy, and yielded only modest correlations with RT3DE-derived RV size and EF: R2 = 0.38 and 0.61, respectively (see Figure).
Conclusion: 2DE assessments offer limited diagnostic sensitivity for detection of abnormalities of RV size and systolic function, and yield only modest quantitative accuracy in patients with PAH, when compared to RT3DE. These findings have implications for clinical decision-making and for the design of clinical trials which utilize RV morphology and function as endpoints.
- © 2011 by American Heart Association, Inc.