Advertisement
Canadian Journal of Cardiology

Three-Dimensional Echocardiography Right Ventricular Volumes and Ejection Fraction Reference Values in Children: A North American Multicentre Study

      Abstract

      Background

      Three-dimensional echocardiography (3DE) evaluation of right ventricular (RV) volumes and ejection fraction (EF) is increasingly used for clinical serial assessments and management in children. This study aims to generate sex-specific reference values and z-score equations for RV volumetric parameters, independent of age and body size indices, derived from multiple populations across North America.

      Methods

      We prospectively recruited 455 healthy children (ages 0 to 18 years) from 5 centres. 3DE of the RV were acquired using various vendors with analyses performed offline using vendor-independent software. 3DE datasets with all walls of the RV endocardium visible were included. We reported data on RV EF, and generated z scores for end-systolic volumes (ESV), end-diastolic volumes (EDV) and stroke volume (SV). Differences between the sexes were explored.

      Results

      Of 455 3DE datasets, 312 (68%) met imaging criteria for analysis. Median age was 10.1 years (interquartile ratio [IQR]: 5.6, 14.0) with 17% being younger than 3 years of age. The mean and standard deviation for RV EDV, ESV, and SV for male and female patients were reported. We provided a downloadable z-score calculator with height and weight as independent variables to facilitate clinical utility. Although statistically significant differences between male and female RVEF was present (female 52.9 ± 3.9% vs male 51.6 ± 3.5%, P = 0.006), after adjusting for age, height, and weight, the magnitude of difference was clinically insignificant.

      Conclusions

      Sex-specific reference values for pediatric RV volumes and EF, and z-score equations were derived from children 3DE datasets across 5 centres in North America.

      Résumé

      Contexte

      L’évaluation par échocardiographie tridimensionnelle (E3D) des volumes et de la fraction d’éjection (FE) du ventricule droit (VD) est de plus en plus mise à contribution pour les évaluations séquentielles et la prise en charge cliniques des enfants. Cette étude vise à présenter des valeurs de référence sexospécifiques et des formules de calcul du score z applicables aux paramètres volumétriques du VD, indépendamment de l’âge et des indices de taille corporelle, à partir de données acquises au sein de plusieurs populations en Amérique du Nord.

      Méthodologie

      Nous avons recruté prospectivement 455 enfants et adolescents en bonne santé (âgés de 0 à 18 ans) dans cinq centres. Les images E3D du VD ont été captées à l’aide d’appareils de différents fournisseurs. Leur analyse a été effectuée hors ligne au moyen de logiciels indépendants des fournisseurs. Les ensembles de données E3D permettant de visualiser toutes les parois de l’endocarde du VD ont été retenus. Nous avons consigné les données sur la FE du VD et calculé les scores z des volumes télésystolique (VTS), télédiastolique (VTD) et systolique (VS). Les différences entre les sexes ont été étudiées.

      Résultats

      Parmi les 455 ensembles de données E3D examinés, 312 (68 %) répondaient aux critères d’imagerie pour les besoins de notre analyse. L’âge médian était de 10,1 ans (rapport interquartile [RIQ] : 5,6, 14,0); 17 % des sujets avaient moins de 3 ans. L’écart moyen et l’écart type du VTD, du VTS et du VS du ventricule droit ont été consignés chez les patients des deux sexes. Nous avons fourni un calculateur de score z téléchargeable traitant la taille et le poids comme des variables indépendantes à des fins pratiques. Des différences significatives sur le plan statistique entre les garçons et les filles ont été notées au chapitre de la FE du VD (52,9 ± 3,9 % chez les filles vs 51,6 ± 3,5 % chez les garçons, p = 0,006). Toutefois, après correction en fonction de l’âge, de la taille et du poids, ces différences se sont révélées non significatives sur le plan clinique.

      Conclusions

      Des valeurs de référence sexospécifiques des volumes et de la FE du VD, de même que des formules de calcul du score z, ont été obtenues à partir d’ensembles de données E3D pédiatriques acquises dans cinq centres situés en Amérique du Nord.

      Graphical abstract

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cheung Y.F.
        Functional assessment for congenital heart disease.
        Korean Circ J. 2014; 44: 59-73
        • Jone P.N.
        • Duchateau N.
        • Pan Z.
        • Ivy D.D.
        • Moceri P.
        Right ventricular area strain from 3-dimensional echocardiography: mechanistic insight of right ventricular dysfunction in pediatric pulmonary hypertension.
        J Heart Lung Transplant. 2021; 40: 138-148
        • Jone P.N.
        • Patel S.S.
        • Cassidy C.
        • Ivy D.D.
        Three-dimensional echocardiography of right ventricular function correlates with severity of pediatric pulmonary hypertension.
        Congenit Heart Dis. 2016; 11: 562-569
        • Jone P.N.
        • Schafer M.
        • Pan Z.
        • Bremen C.
        • Ivy D.D.
        3D echocardiographic evaluation of right ventricular function and strain: a prognostic study in paediatric pulmonary hypertension.
        Eur Heart J Cardiovasc Imaging. 2018; 19: 1026-1033
        • Kutty S.
        • Graney B.A.
        • Khoo N.S.
        • et al.
        Serial assessment of right ventricular volume and function in surgically palliated hypoplastic left heart syndrome using real-time transthoracic three-dimensional echocardiography.
        J Am Soc Echocardiogr. 2012; 25: 682-689
        • Khoo N.S.
        • Young A.
        • Occleshaw C.
        • Cowan B.
        • Zeng I.S.
        • Gentles T.L.
        Assessments of right ventricular volume and function using three-dimensional echocardiography in older children and adults with congenital heart disease: comparison with cardiac magnetic resonance imaging.
        J Am Soc Echocardiogr. 2009; 22: 1279-1288
        • Dragulescu A.
        • Grosse-Wortmann L.
        • Fackoury C.
        • Mertens L.
        Echocardiographic assessment of right ventricular volumes: a comparison of different techniques in children after surgical repair of tetralogy of Fallot.
        Eur Heart J Cardiovasc Imaging. 2012; 13: 596-604
        • Renella P.
        • Marx G.R.
        • Zhou J.
        • Gauvreau K.
        • Geva T.
        Feasibility and reproducibility of three-dimensional echocardiographic assessment of right ventricular size and function in pediatric patients.
        J Am Soc Echocardiogr. 2014; 27: 903-910
        • Laser K.T.
        • Horst J.P.
        • 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: 1087-1097
        • Laser K.T.
        • Karabiyik A.
        • Korperich H.
        • et al.
        Validation and reference values for three-dimensional echocardiographic right ventricular volumetry in children: a multicenter study.
        J Am Soc Echocardiogr. 2018; 31: 1050-1063
        • Muraru D.
        • Spadotto V.
        • Cecchetto A.
        • et al.
        New speckle-tracking algorithm for right ventricular volume analysis from three-dimensional echocardiographic data sets: validation with cardiac magnetic resonance and comparison with the previous analysis tool.
        Eur Heart J Cardiovasc Imaging. 2016; 17: 1279-1289
        • Lang R.M.
        • Badano L.P.
        • 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: 1-39.e14
        • Lopez L.
        • Colan S.D.
        • Frommelt P.C.
        • et al.
        Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council.
        J Am Soc Echocardiogr. 2010; 23 (quiz 576-467): 465-495
        • Plante V.
        • Gobeil L.
        • Xiong W.T.
        • et al.
        Alternative to body surface area as a solution to correct systematic bias in pediatric echocardiography z scores.
        Can J Cardiol. 2021; 37: 1790-1797
        • Cardinal M.P.
        • Blais S.
        • Dumas A.
        • et al.
        Novel z scores to correct biases due to ventricular volume indexing to body surface area in adolescents and young adults.
        Can J Cardiol. 2021; 37: 417-424
        • Foster B.J.
        • Gao T.
        • Mackie A.S.
        • et al.
        Limitations of expressing left ventricular mass relative to height and to body surface area in children.
        J Am Soc Echocardiogr. 2013; 26: 410-418
        • Kumar S.
        • Kelly A.S.
        Review of childhood obesity: from epidemiology, etiology, and comorbidities to clinical assessment and treatment.
        Mayo Clin Proc. 2017; 92: 251-265
        • Altman D.G.
        Construction of age-related reference centiles using absolute residuals.
        Stat Med. 1993; 12: 917-924
        • Mahgerefteh J.
        • Lai W.
        • Colan S.
        • et al.
        Height versus body surface area to normalize cardiovascular measurements in children using the Pediatric Heart Network Echocardiographic Z-Score Database.
        Pediatr Cardiol. 2021; 42: 1284-1292
        • Medvedofsky D.
        • Mor-Avi V.
        • Kruse E.
        • et al.
        Quantification of right ventricular size and function from contrast-enhanced three-dimensional echocardiographic images.
        J Am Soc Echocardiogr. 2017; 30: 1193-1202
        • van der Ven J.P.G.
        • Sadighy Z.
        • Valsangiacomo Buechel E.R.
        • et al.
        Multicentre reference values for cardiac magnetic resonance imaging derived ventricular size and function for children aged 0-18 years.
        Eur Heart J Cardiovasc Imaging. 2020; 21: 102-113
        • Kawel-Boehm N.
        • Hetzel S.J.
        • Ambale-Venkatesh B.
        • et al.
        Reference ranges ("normal values") for cardiovascular magnetic resonance (CMR) in adults and children: 2020 update.
        J Cardiovasc Magn Reson. 2020; 22: 87
        • Tamborini G.
        • Marsan N.A.
        • Gripari P.
        • et al.
        Reference values for right ventricular volumes and ejection fraction with real-time three-dimensional echocardiography: evaluation in a large series of normal subjects.
        J Am Soc Echocardiogr. 2010; 23: 109-115
        • Maffessanti F.
        • Muraru D.
        • Esposito R.
        • et al.
        Age-, body size-, and sex-specific reference values for right ventricular volumes and ejection fraction by three-dimensional echocardiography: a multicenter echocardiographic study in 507 healthy volunteers.
        Circ Cardiovasc Imaging. 2013; 6: 700-710
        • van de Veerdonk M.C.
        • Kind T.
        • Marcus J.T.
        • et al.
        Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy.
        J Am Coll Cardiol. 2011; 58: 2511-2519
        • Son J.S.
        • James A.
        • Fan C.S.
        • et al.
        Prognostic value of serial echocardiography in hypoplastic left heart syndrome.
        Circ Cardiovasc Imaging. 2018; 11e006983
        • Shimada Y.J.
        • Shiota M.
        • Siegel R.J.
        • Shiota T.
        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: 943-953