Comparison of advanced echocardiographic right ventricular functional parameters with cardiovascular magnetic resonance in adult congenital heart disease.

ABSTRACT

Aims: Advanced transthoracic echocardiography (TTE) using volumetric and deformational indices provides detailed quantification of right ventricular (RV) function in adults with congenital heart disease (ACHD). Two-dimensional multi-plane echocardiography (2D-MPE) has demonstrated regional wall differences in RV longitudinal strain (LS). This study aims to evaluate the association of these parameters with cardiovascular magnetic resonance (CMR). Methods and results: One-hundred stable ACHD patients with primarily affected RVs were included (age 50 ± 5 years; 53% male). Conventional and advanced echocardiographic RV functional parameters were compared with CMR-derived RV function. Advanced echocardiographic RV functional parameters were measurable in approximately one-half of the study cohort, while multi-wall LS assessment feasibility was lower. CMR RV ejection fraction (CMR-RVEF) was moderately correlated with deformational, area, and volumetric parameters [RV global LS (lateral wall and septum), n = 55 r = -0.62, P < 0.001; RV wall average LS, n = 34 r = -0.49, P = 0.002; RV lateral wall LS, n = 56 r = -0.45, P < 0.001; fractional area change, n = 67 r = 0.48, P < 0.001; 3D-RVEF, n = 48 r = 0.40, P = 0.005]. Conventional measurements such as TAPSE and RV S' correlated poorly. RV global LS best identified CMR-RVEF < 45% (area under the curve 0.84, P < 0.001 cut-off value -19% sensitivity 100%, specificity 57%). RVEF and LS values were significantly higher when measured by CMR compared with TTE (mean difference RVEF 5 [-9 to 18] %; lateral (free) wall LS -7 [7 to -21] %; RV global LS -6 [5 to -16] %) while there was no association between respective LS values. Conclusion: In ACHD patients, advanced echocardiographic RV functional parameters are moderately correlated with CMR-RVEF, although significant differences exist between indices measurable by both modalities.