Key result
Echocardiographic measurements of right ventricular stroke volume at the mid-pulmonary artery and right ventricular outflow tract showed fair to excellent agreement (ICC 0.56-0.89) but had significant bias (1.9-11.3 mL) and wide limits of agreement, indicating they cannot be used interchangeably.
Why the study?
Right ventricular stroke volume can be calculated via Doppler echocardiography at multiple sites in the right chambers, but the agreement between calculated stroke volumes at these sites is unknown.
Do stroke volume measurements at the mid-pulmonary artery agree with those at the right ventricular outflow tract in patients undergoing echocardiography?
Cross-Sectional (n=406)
No
Do stroke volume measurements at the mid-pulmonary artery agree with those at the right ventricular outflow tract in patients undergoing echocardiography?
Stroke volume calculated at the mid-pulmonary artery and right ventricular outflow tract show significant bias and wide limits of agreement, meaning these measurement sites cannot be used interchangeably in clinical practice.
BACKGROUND: Right ventricular (RV) stroke volume (SV) can be calculated via Doppler echocardiography at multiple sites in the right chambers. However, the agreement between the calculated SVs at these sites is unknown. We aimed to assess the repeatability, reliability, and precision of the distal right ventricular outflow tract diameter (RVOTD), the mid-pulmonary artery diameter (MPAD), the right ventricular outflow tract velocity time integral (VTI), and the mid-pulmonary artery velocity time integral (MPAVTI). Additionally, we evaluated the agreement between RVOTSV and MPASV. METHODS: Four observers each evaluated approximately 100 patients (n = 406). Basic measurements were made over three cardiac cycles, and the repeatability, reliability, and precision of the measurements were calculated. The agreement between the two methods was presented as intraclass correlation coefficients. RESULTS: The repeatability coefficient ranges for RVOTD, MPAD, RVOTVTI, and MPAVTI were 2-3 mm, 2-4 mm, 2.1-2.8 cm, and 2.4-4.1 cm, respectively. The minimal detectable change ranges for these variables were 2-4 mm, 2-5 mm, 2.2-3.0 cm, and 2.6-4.3 cm, respectively. The respective precision ranges for RVOTD, MPAD, RVOTVTI, and MPAVTI were 2.7-4.7%, 2.4-5.4%, 5.0-7.4%, and 5.4-9.2%. There were significant correlations and agreements between MPASV and RVOTSV, with the Pearson correlation coefficient ranging from 0.63 to 0.89 (P < 0.001). The intraclass correlation coefficient ranged from 0.56 to 0.89 (P < 0.001), although there was a significant bias of 1.9-11.3 mL (P < 0.001). CONCLUSIONS: The RVOTD, MPAD, RVOTVTI, and MPAVTI measurements were repeatable, reliable, and precise. The agreement between RVOTSV and MPASV ranged from fair to excellent, although significant bias, along with a wide limit of agreement, was observed. Consequently, these methods cannot be used interchangeably.
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Mohseni‐Badalabadi et al. (2024) conducted a cross-sectional in Patients referred for echocardiography (n=406). Echocardiographic measurement of right ventricular stroke volume at the mid-pulmonary artery (MPASV) vs. Echocardiographic measurement of right ventricular stroke volume at the right ventricular outflow tract (RVOTSV) was evaluated on Agreement between MPASV and RVOTSV (Intraclass correlation coefficient) (ICC 0.56-0.89, 95% CI 0.31-0.93, p=<0.001). Echocardiographic measurements of right ventricular stroke volume at the mid-pulmonary artery and right ventricular outflow tract showed fair to excellent agreement (ICC 0.56-0.89) but had significant bias (1.9-11.3 mL) and wide limits of agreement, indicating they cannot be used interchangeably.
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