Twenty-seven patients with pulmonary arterial hypertension were prospectively recruited for same-day echocardiography and cardiovascular magnetic resonance (CMR), which was used as a reference standard. Two-dimensional transthoracic echocardiographic images were acquired with 3D spatial localization equipment to allow 3D reconstruction. Image analysis was performed with dedicated software to obtain end-diastolic volume (EDV) and end-systolic volume (ESV) and RV ejection fraction (EF). The method of disks was used to determine RV volumes on CMR.
Echocardiographic RV volumes correlated well with CMR (EDV, R?= 0.87; ESV, R?= 0.88; EF, R?= 0.75). For interobserver analyses, coefficients of variability were 7.8 ¡À 7.0 % for EDV, 10.2 ¡À 8.0 % for ESV, and 15.4 ¡À 13.8 % for EF. For intraobserver analyses, coefficients of variability were 7.1 ¡À 5.1 % for EDV, 8.3 ¡À 7.0 % for ESV, and 10.9 ¡À 9.2 % for EF. On Bland-Altman analyses, volumes obtained on transthoracic echocardiography (TTE) were slightly larger than those obtained by CMR (¦¤EDVTTE-CMR, 5.8 ¡À 33.7 mL; ¦¤ESVTTE-CMR, 3.5 ¡À 27.8 mL), whereas EFs tended to be slightly higher by CMR (¦¤EFCMR-TTE, 0.5 ¡À 6.5 % ).
Knowledge-based reconstruction provides accurate and reproducible measurements of RV volumes in patients with pulmonary arterial hypertension. Larger studies are needed to confirm these results and to determine the practicality of this approach in daily practice and as an end point in clinical trials.