Comparison between Automatic and Semiautomatic System for the 3D Echocardiographic Multiparametric Evaluation of RV Function and Dimension

Figures

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  Figure 1. Step–by–step analysis of the RV: (A) Acquisition of the full volume from the 4–chamber apical view focused on the RV; (B) after acquisition the system is launched and in apparently 14 s the complete 3D analysis is obtained; in the same panel 3D–2D views allow editing of the borders in case of suboptimal contour; (C,D) by clicking the bottom a 3D analysis with functional curves or a 2D and strain measurements may be easily displayed; (E) the 3D dynamic model of the inflow, outflow and apex of the RV may be rotated and displayed freely.

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  Figure 2. Top panels: results of Bland–Altman analysis for right ventricular free wall longitudinal strain (FWLS), right ventricular fractional area change (RV FAC) tricuspid annular plane systolic excursion (TAPSE) obtained from automatic and semi–automatic 2–dimensional methods. Bottom panels: Results of Bland–Altman analysis for right ventricular end–diastolic volume (RV EDV), right ventricular end–systolic volume (RV ESV) and right ventricular ejection fraction (RV EF) obtained from automatic and semi-automatic methods. Dashed line = bias; solid line = ±2 standard deviations; LOA: limits of agreement.

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  Figure 3. Results of Bland–Altman analysis of the agreement between repeated measurements of right ventricular end–diastolic volume (RV EDV), right ventricular end–systolic volume (RV ESV) and right ventricular ejection fraction (RV EF) for intra–operator (top), inter–operator (middle) and test–retest (bottom) comparisons. Dashed line = bias; soldi line = ±2 standard deviations; LOA: limits of agreement.

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  Figure 4. Patient with an ostium secundum ASD. (A) TEE showing a significant left–to–right shunt at the atrial level. (B) oval shape ASD at transthoracic 3D echo (right atrial view); (C) AI 3DTTE volume and function curves and analysis demonstrating moderate dilation of the RV normal RV systolic function. (D–G) automated analysis of TAPSE, FAC and RVLS obtained by 3D dataset. ASD: atrial septal defect; TEE: transesophageal echocardiography; TTE: transthoracic echocardiography; TAPSE: tricuspid annular plane systolic excursion; FAC: fractional area change; FWLS: free wall longitudinal strain.

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  Figure 5. Patient with severe pulmonary hypertension (top panels) and a case with severe volume overload due to tricuspid regurgitation (bottom panels). (A) four–chamber view showing severe RV dilation; (B) continuous wave Doppler of tricuspid regurgitation indicating severe pulmonary hypertension; (C) AI 3D analysis confirms severe dilatation and dysfunction of the RV; (D) severe tricuspid regurgitation; (E) 3D RV view of the tricuspid valve; (F) AI 3D measurements showing RV dilation with normal RV systolic function.