Vol 28, No 4 (2021)
Original Article
Published online: 2019-03-08

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Usefulness of three-dimensional echocardiography for the assessment of ventricular function in children: Comparison with cardiac magnetic resonance, with a focus on patients with arrhythmia

Halszka Kamińska1, Łukasz A. Małek2, Marzena Barczuk-Falęcka3, Bożena Werner1
Pubmed: 30912575
Cardiol J 2021;28(4):549-557.


Background: Focusing on patients with arrhythmia, the aims of this study was to assess ventricular function in children using three-dimensional echocardiography (3D-ECHO) and to compare the results to those obtained with cardiac magnetic resonance (CMR).
Methods: The study group consisted of 43 children in whom 3D-ECHO and CMR were performed. Twenty-five patients had a ventricular arrhythmia, 7 left ventricular cardiomyopathies, 9 proved to be healthy. In all children, 3D-ECHO (offline analysis) was used to assess ventricular ejection fraction (EF). The results were compared to CMR using the Bland-Altman analysis and linear regression. The Student paired T-test was used to compare of means between both modalities.
Results: The relation between the results derived from both methods is linear (for left ventricle: estimated slope = 1.031, p < 0.0001, R-squared = 0.998; for right ventricle: estimated slope = 0.993, p < 0.0001, R-squared = 0.998). In spite of minimal mean differences between results for both ventricles and narrow 95% confidence intervals, the paired t-test proved those differences not to be significant (p > 0.05) for the right ventricle but statistically significant (p < 0.05) for the left ventricle, for which the left ventricular EF calculated in 3D-ECHO was systematically underestimated with a mean difference of –1.8% ± 2.6% (p < 0.0001).
Conclusions: Three-dimensional echocardiography assessment of both left and right ventricular EF in children showed high significant correlation and agreement with CMR. 3D-ECHO could be a valuable tool in follow-up of children with arrhythmic disorders requiring regular assessment of ventricular function.

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  1. Helbing WA, Ouhlous M. Cardiac magnetic resonance imaging in children. Pediatr Radiol. 2015; 45(1): 20–26.
  2. Barczuk-Falęcka M, Małek ŁA, Roik D, et al. Right ventricular end-systolic area as a simple first-line marker predicting right ventricular enlargement and decreased systolic function in children referred for cardiac magnetic resonance imaging. Clin Radiol. 2018; 73(6): 592.e9–592.e14.
  3. Bland JM, Altman DG. Applying the right statistics: analyses of measurement studies. Ultrasound Obstet Gynecol. 2003; 22(1): 85–93.
  4. Ratcliffe M, Starr N. Patient management exchange: Cardiac arrhythmias in children. J Pediatric Health Care. 2000; 14(3): 0127–0129.
  5. Kim SS, Ko SM, Song MG, et al. Assessment of global function of left ventricle with dual-source CT in patients with severe arrhythmia: a comparison with the use of two-dimensional transthoracic echocardiography. Int J Cardiovasc Imaging. 2010; 26(Suppl 2): 213–221.
  6. Do VB, Tsai WC, Lin YJ, et al. The different substrate characteristics of arrhythmogenic triggers in idiopathic right ventricular outflow tract tachycardia and arrhythmogenic right ventricular dysplasia: new insight from noncontact mapping. PLoS One. 2015; 10(10): e0140167.
  7. Hennig A, Salel M, Sacher F, et al. High-resolution three-dimensional late gadolinium-enhanced cardiac magnetic resonance imaging to identify the underlying substrate of ventricular arrhythmia. Europace. 2018; 20(FI2): f179–f191.
  8. Raymond-Paquin A, Nattel S, Wakili R, et al. Mechanisms and clinical significance of arrhythmia-induced cardiomyopathy. Can J Cardiol. 2018; 34(11): 1449–1460.
  9. Li KaH, Bazoukis G, Liu T, et al. Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) in clinical practice. J Arrhythm. 2018; 34(1): 11–22.
  10. Chungsomprasong P, Hamilton R, Luining W, et al. Left ventricular function in children and adolescents with arrhythmogenic right ventricular cardiomyopathy. Am J Cardiol. 2017; 119(5): 778–784.
  11. Steinmetz M, Krause U, Lauerer P, et al. Diagnosing ARVC in pediatric patients applying the revised task force criteria: importance of imaging, 12-lead ECG, and genetics. Pediatr Cardiol. 2018 [Epub ahead of print].
  12. Mast TP, James CA, Calkins H, et al. Evaluation of structural progression in arrhythmogenic right ventricular dysplasia/cardiomyopathy. JAMA Cardiol. 2017; 2(3): 293–302.
  13. Mast TP, Taha K, Cramer MJ, et al. The prognostic value of right ventricular deformation imaging in early arrhythmogenic right ventricular cardiomyopathy. JACC Cardiovasc Imaging. 2018 [Epub ahead of print].
  14. Sarvari SI, Haugaa KH, Anfinsen OG, et al. Right ventricular mechanical dispersion is related to malignant arrhythmias: a study of patients with arrhythmogenic right ventricular cardiomyopathy and subclinical right ventricular dysfunction. Eur Heart J. 2011; 32(9): 1089–1096.
  15. Pietrzak R, Werner B. Postsystolic shortening is associated with altered right ventricular function in children after tetralogy of Fallot surgical repair. PLoS One. 2017; 12(1): e0169178.
  16. Lipczyńska M, Szymański P, Kumor M, et al. Global longitudinal strain may identify preserved systolic function of the systemic right ventricle. Can J Cardiol. 2015; 31(6): 760–766.
  17. Sano H, Tanaka H, Motoji Y, et al. Right ventricular function and right-heart echocardiographic response to therapy predict long-term outcome in patients with pulmonary hypertension. Can J Cardiol. 2015; 31(4): 529–536.
  18. Rudski L, Lai W, Afilalo J, et al. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2010; 23(7): 685–713.
  19. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1): 1–39.e14.
  20. Velasco O, Beckett MQ, James AW, et al. Real-Time three-dimensional echocardiography: characterization of cardiac anatomy and function-current clinical applications and literature review update. Biores Open Access. 2017; 6(1): 15–18.
  21. Badano LP, Boccalini F, Muraru D, et al. Current clinical applications of transthoracic three-dimensional echocardiography. J Cardiovasc Ultrasound. 2012; 20(1): 1–22.
  22. Surkova E, Muraru D, Aruta P, et al. Current clinical applications of three-dimensional echocardiography: when the technique makes the difference. Curr Cardiol Rep. 2016; 18(11): 109.
  23. Shimada YJ, Shiota T. A meta-analysis and investigation for the source of bias of left ventricular volumes and function by three-dimensional echocardiography in comparison with magnetic resonance imaging. Am J Cardiol. 2011; 107(1): 126–138.
  24. Shimada YJ, Shiota M, Siegel RJ, et al. Accuracy of right ventricular volumes and function determined by three-dimensional echocardiography in comparison with magnetic resonance imaging: a meta-analysis study. J Am Soc Echocardiogr. 2010; 23(9): 943–953.
  25. Hoffmann R, Barletta G, von Bardeleben S, et al. Analysis of left ventricular volumes and function: a multicenter comparison of cardiac magnetic resonance imaging, cine ventriculography, and unenhanced and contrast-enhanced two-dimensional and three-dimensional echocardiography. J Am Soc Echocardiogr. 2014; 27(3): 292–301.
  26. Hamilton-Craig CR, Stedman K, Maxwell R, et al. Accuracy of quantitative echocardiographic measures of right ventricular function as compared to cardiovascular magnetic resonance. Int J Cardiol Heart Vasc. 2016; 12: 38–44.
  27. Lu X, Nadvoretskiy V, Bu L, et al. Accuracy and reproducibility of real-time three-dimensional echocardiography for assessment of right ventricular volumes and ejection fraction in children. J Am Soc Echocardiogr. 2008; 21(1): 84–89.
  28. Park JB, Lee SP, Lee JH, et al. Quantification of right ventricular volume and function using single-beat three-dimensional echocardiography: a validation study with cardiac magnetic resonance. J Am Soc Echocardiogr. 2016; 29(5): 392–401.
  29. Jenkins C, Chan J, Bricknell K, et al. Reproducibility of right ventricular volumes and ejection fraction using real-time three-dimensional echocardiography: comparison with cardiac MRI. Chest. 2007; 131(6): 1844–1851.
  30. Balluz R, Liu L, Zhou X, et al. Real time three-dimensional echocardiography for quantification of ventricular volumes, mass, and function in children with congenital and acquired heart diseases. Echocardiography. 2013; 30(4): 472–482.
  31. D'Anna C, Caputi A, Natali B, et al. Improving the role of echocardiography in studying the right ventricle of repaired tetralogy of Fallot patients: comparison with cardiac magnetic resonance. Int J Cardiovasc Imaging. 2018; 34(3): 399–406.
  32. Windram JD, Dragelescu A, Benson L, et al. Myocardial dimensions in children with hypertrophic cardiomyopathy: a comparison between echocardiography and cardiac magnetic resonance imaging. Can J Cardiol. 2016; 32(12): 1507–1512.
  33. Laser KT, Horst JP, Barth P, et al. Knowledge-based reconstruction of right ventricular volumes using real-time three-dimensional echocardiographic as well as cardiac magnetic resonance images: comparison with a cardiac magnetic resonance standard. J Am Soc Echocardiogr. 2014; 27(10): 1087–1097.
  34. Knight DS, Grasso AE, Quail MA, et al. Accuracy and reproducibility of right ventricular quantification in patients with pressure and volume overload using single-beat three-dimensional echocardiography. J Am Soc Echocardiogr. 2015; 28(3): 363–374.
  35. Nagata Y, Wu VCC, Kado Y, et al. Prognostic value of right ventricular ejection fraction assessed by transthoracic 3D echocardiography. Circ Cardiovasc Imaging. 2017; 10(2).
  36. Kamińska H, Werner B. Three-dimensional echocardiography in the assessment of ventricular function in children: pros, cons, and hopes. Kardiol Pol. 2019; 77(1): 12–17.