Utility of transthoracic echocardiography to estimate severity of right ventricular dysfunction: An MRI comparison study

Suraj Kapa, Richard Elias, Heidi J. Connolly, Imran S. Syed, Samuel J Asirvatham

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Prognostic implications of severe right ventricular (RV) dysfunction are difficult to assess because of limitations in functional characterization using standard echocardiography (TTE) and the cost and availability of options such as MRI. We sought to determine how assessments of RV dysfunction via TTE correlate with RV ejection fraction (EF) by MRI. Patients undergoing MRI and TTE within 21 days of one another were included. Left ventricular (LV) and RV EF were recorded from MRI and subjective assessment of RV function (normal, mild, moderate, or severe dysfunction), right ventricular index of myocardial performance (RIMP), and right ventricular systolic pressure (RVSP) were recorded from TTE. Patients were considered to have significant RV dysfunction if EF ≤ 35% on MRI and normal function if EF ≥ 45%. A total of 474 patients were included (age 50 ± 12, 57% male). Of these, 363 (76.6%) had normal function, 54 (11.4%) had mild dysfunction, 41 (8.6%) had moderate dysfunction, and 16 (3.4%) had severe dysfunction on TTE. Moderate or severe dysfunction had good sensitivity (80%) and specificity (97%) for RV EF ≤ 35%. Furthermore, RIMP>0.70 and RVSP>70 mm Hg were very specific for RV EF ≤ 35% (sensitivity = 29%, 22%, respectively; specificity = 98%, 99%, respectively). Specificity and sensitivity of TTE assessments did not change if LV function or disease indication was considered. A subjective assessment of moderate to severe RV dysfunction on TTE compares favorably with quantitative MRI assessment of the RV EF. Further study is needed to evaluate whether this comparability is true across institutions.

Original languageEnglish (US)
Pages (from-to)251-261
Number of pages11
JournalInternational Journal of Cardiovascular Imaging
Volume28
Issue number2
DOIs
StatePublished - Feb 2012

Fingerprint

Right Ventricular Dysfunction
Stroke Volume
Echocardiography
Ventricular Pressure
Blood Pressure
Sensitivity and Specificity
Right Ventricular Function
Left Ventricular Function
Costs and Cost Analysis

Keywords

  • Heart failure
  • MRI
  • Right ventricular function
  • Transthoracic echocardiogram

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Utility of transthoracic echocardiography to estimate severity of right ventricular dysfunction : An MRI comparison study. / Kapa, Suraj; Elias, Richard; Connolly, Heidi J.; Syed, Imran S.; Asirvatham, Samuel J.

In: International Journal of Cardiovascular Imaging, Vol. 28, No. 2, 02.2012, p. 251-261.

Research output: Contribution to journalArticle

@article{8454f736940843babe5db288cb0522b6,
title = "Utility of transthoracic echocardiography to estimate severity of right ventricular dysfunction: An MRI comparison study",
abstract = "Prognostic implications of severe right ventricular (RV) dysfunction are difficult to assess because of limitations in functional characterization using standard echocardiography (TTE) and the cost and availability of options such as MRI. We sought to determine how assessments of RV dysfunction via TTE correlate with RV ejection fraction (EF) by MRI. Patients undergoing MRI and TTE within 21 days of one another were included. Left ventricular (LV) and RV EF were recorded from MRI and subjective assessment of RV function (normal, mild, moderate, or severe dysfunction), right ventricular index of myocardial performance (RIMP), and right ventricular systolic pressure (RVSP) were recorded from TTE. Patients were considered to have significant RV dysfunction if EF ≤ 35{\%} on MRI and normal function if EF ≥ 45{\%}. A total of 474 patients were included (age 50 ± 12, 57{\%} male). Of these, 363 (76.6{\%}) had normal function, 54 (11.4{\%}) had mild dysfunction, 41 (8.6{\%}) had moderate dysfunction, and 16 (3.4{\%}) had severe dysfunction on TTE. Moderate or severe dysfunction had good sensitivity (80{\%}) and specificity (97{\%}) for RV EF ≤ 35{\%}. Furthermore, RIMP>0.70 and RVSP>70 mm Hg were very specific for RV EF ≤ 35{\%} (sensitivity = 29{\%}, 22{\%}, respectively; specificity = 98{\%}, 99{\%}, respectively). Specificity and sensitivity of TTE assessments did not change if LV function or disease indication was considered. A subjective assessment of moderate to severe RV dysfunction on TTE compares favorably with quantitative MRI assessment of the RV EF. Further study is needed to evaluate whether this comparability is true across institutions.",
keywords = "Heart failure, MRI, Right ventricular function, Transthoracic echocardiogram",
author = "Suraj Kapa and Richard Elias and Connolly, {Heidi J.} and Syed, {Imran S.} and Asirvatham, {Samuel J}",
year = "2012",
month = "2",
doi = "10.1007/s10554-011-9810-9",
language = "English (US)",
volume = "28",
pages = "251--261",
journal = "International Journal of Cardiovascular Imaging",
issn = "1569-5794",
publisher = "Springer Netherlands",
number = "2",

}

TY - JOUR

T1 - Utility of transthoracic echocardiography to estimate severity of right ventricular dysfunction

T2 - An MRI comparison study

AU - Kapa, Suraj

AU - Elias, Richard

AU - Connolly, Heidi J.

AU - Syed, Imran S.

AU - Asirvatham, Samuel J

PY - 2012/2

Y1 - 2012/2

N2 - Prognostic implications of severe right ventricular (RV) dysfunction are difficult to assess because of limitations in functional characterization using standard echocardiography (TTE) and the cost and availability of options such as MRI. We sought to determine how assessments of RV dysfunction via TTE correlate with RV ejection fraction (EF) by MRI. Patients undergoing MRI and TTE within 21 days of one another were included. Left ventricular (LV) and RV EF were recorded from MRI and subjective assessment of RV function (normal, mild, moderate, or severe dysfunction), right ventricular index of myocardial performance (RIMP), and right ventricular systolic pressure (RVSP) were recorded from TTE. Patients were considered to have significant RV dysfunction if EF ≤ 35% on MRI and normal function if EF ≥ 45%. A total of 474 patients were included (age 50 ± 12, 57% male). Of these, 363 (76.6%) had normal function, 54 (11.4%) had mild dysfunction, 41 (8.6%) had moderate dysfunction, and 16 (3.4%) had severe dysfunction on TTE. Moderate or severe dysfunction had good sensitivity (80%) and specificity (97%) for RV EF ≤ 35%. Furthermore, RIMP>0.70 and RVSP>70 mm Hg were very specific for RV EF ≤ 35% (sensitivity = 29%, 22%, respectively; specificity = 98%, 99%, respectively). Specificity and sensitivity of TTE assessments did not change if LV function or disease indication was considered. A subjective assessment of moderate to severe RV dysfunction on TTE compares favorably with quantitative MRI assessment of the RV EF. Further study is needed to evaluate whether this comparability is true across institutions.

AB - Prognostic implications of severe right ventricular (RV) dysfunction are difficult to assess because of limitations in functional characterization using standard echocardiography (TTE) and the cost and availability of options such as MRI. We sought to determine how assessments of RV dysfunction via TTE correlate with RV ejection fraction (EF) by MRI. Patients undergoing MRI and TTE within 21 days of one another were included. Left ventricular (LV) and RV EF were recorded from MRI and subjective assessment of RV function (normal, mild, moderate, or severe dysfunction), right ventricular index of myocardial performance (RIMP), and right ventricular systolic pressure (RVSP) were recorded from TTE. Patients were considered to have significant RV dysfunction if EF ≤ 35% on MRI and normal function if EF ≥ 45%. A total of 474 patients were included (age 50 ± 12, 57% male). Of these, 363 (76.6%) had normal function, 54 (11.4%) had mild dysfunction, 41 (8.6%) had moderate dysfunction, and 16 (3.4%) had severe dysfunction on TTE. Moderate or severe dysfunction had good sensitivity (80%) and specificity (97%) for RV EF ≤ 35%. Furthermore, RIMP>0.70 and RVSP>70 mm Hg were very specific for RV EF ≤ 35% (sensitivity = 29%, 22%, respectively; specificity = 98%, 99%, respectively). Specificity and sensitivity of TTE assessments did not change if LV function or disease indication was considered. A subjective assessment of moderate to severe RV dysfunction on TTE compares favorably with quantitative MRI assessment of the RV EF. Further study is needed to evaluate whether this comparability is true across institutions.

KW - Heart failure

KW - MRI

KW - Right ventricular function

KW - Transthoracic echocardiogram

UR - http://www.scopus.com/inward/record.url?scp=84861481584&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861481584&partnerID=8YFLogxK

U2 - 10.1007/s10554-011-9810-9

DO - 10.1007/s10554-011-9810-9

M3 - Article

C2 - 21279688

AN - SCOPUS:84861481584

VL - 28

SP - 251

EP - 261

JO - International Journal of Cardiovascular Imaging

JF - International Journal of Cardiovascular Imaging

SN - 1569-5794

IS - 2

ER -