Accuracy of Shunt Volume Measured by Three-Dimensional Echocardiography and Cardiac Magnetic Resonance in Patients with an Atrial Septal Defect and a Dilated Right Ventricle

Yoshiki Yanagi; Masashi Amano; Yurie Tamai; Ayaka Mizumoto; Shoko Nakagawa; Kenji Moriuchi; Ryotaro Asano; Shinichi Kurashima; Yuki Irie; Takahiro Sakamoto; Makoto Amaki; Hideaki Kanzaki; Yasutoshi Ohta; Yoshiaki Morita; Takeshi Ogo; Takeshi Kitai; Chisato Izumi

doi:10.1016/j.echo.2024.04.016

Accuracy of Shunt Volume Measured by Three-Dimensional Echocardiography and Cardiac Magnetic Resonance in Patients with an Atrial Septal Defect and a Dilated Right Ventricle

J Am Soc Echocardiogr. 2024 May 14:S0894-7317(24)00221-9. doi: 10.1016/j.echo.2024.04.016. Online ahead of print.

Authors

Yoshiki Yanagi¹, Masashi Amano², Yurie Tamai³, Ayaka Mizumoto³, Shoko Nakagawa⁴, Kenji Moriuchi⁴, Ryotaro Asano⁵, Shinichi Kurashima⁴, Yuki Irie⁴, Takahiro Sakamoto⁴, Makoto Amaki⁴, Hideaki Kanzaki⁴, Yasutoshi Ohta⁶, Yoshiaki Morita⁶, Takeshi Ogo⁵, Takeshi Kitai⁴, Chisato Izumi⁴

Affiliations

¹ Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Clinical Laboratory, National Cerebral and Cardiovascular Center, Suita, Japan.
² Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: m.amano.swyt@gmail.com.
³ Department of Clinical Laboratory, National Cerebral and Cardiovascular Center, Suita, Japan.
⁴ Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan.
⁵ Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
⁶ Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan.

PMID: 38754748
DOI: 10.1016/j.echo.2024.04.016

Abstract

Background: The accuracy of right ventricular (RV) quantification by three-dimensional echocardiography (3DE) has been reported mainly in patients with a normal RV. However, there are no data regarding the accuracy of 3DE in patients with a dilated RV, as in shunt diseases. In this study, we evaluated the accuracy of 3DE and that of volumetric cardiac magnetic resonance (CMR) for assessment of RV and left ventricular (LV) stroke volume (SV) and the pulmonary (Q_p)/systemic (Q_s) blood flow ratio in patients with an atrial septal defect (ASD) using the two-dimensional phase contrast (2DPC) method as the gold standard.

Methods: We retrospectively investigated 83 patients with ASD who underwent transcatheter closure and clinically indicated CMR and 3DE examinations. Q_p/Q_s was calculated using RV and LV SV measured by full-volume volumetric 3DE (Vol-3DE) and CMR (Vol-CMR) and by two-dimensional pulse Doppler quantification (2D-Dop); the parameters were compared using 2DPC-CMR as the gold standard.

Results: There was no significant difference in the Q_p/Q_s value between 2DPC-CMR and Vol-3DE (2.29 ± 0.70 vs. 2.21 ± 0.63, P=0.79) and 2D-Dop (vs. 2.21 ± 0.65, P=1.00); however, a significant difference was found between 2DPC-CMR and Vol-CMR (P<0.001). The Q_p/Q_s value obtained using Vol-3DE showed the best correlation with 2DPC-CMR (r=0.93, P<0.001). The RV and LV SV values obtained by Vol-3DE showed the best correlation with 2DPC-CMR (RV SV, r=0.82, P<0.001; LV SV, r=0.73, P<0.001), although the absolute values were underestimated.

Conclusion: Qp/Qs was more accurately evaluated by Vol-3DE than by Vol-CMR or 2D-Dop. 3DE assessment was feasible and reproducible even in a dilated RV.

Keywords: atrial septal defect; cardiac magnetic resonance; left ventricle; right ventricle; three-dimensional echocardiography.