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Journal of Cardiovascular Magnetic Resonance

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Open Access 01-12-2008 | Research

Evaluating the systemic right ventricle by CMR: the importance of consistent and reproducible delineation of the cavity

Authors: Michiel M Winter, Flip JP Bernink, Maarten Groenink, Berto J Bouma, Arie PJ van Dijk, Willem A Helbing, Jan GP Tijssen, Barbara JM Mulder

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2008

Abstract

Background

The method used to delineate the boundary of the right ventricle (RV), relative to the trabeculations and papillary muscles in cardiovascular magnetic resonance (CMR) ventricular volume analysis, may matter more when these structures are hypertrophied than in individuals with normal cardiovascular anatomy. This study aimed to compare two methods of cavity delineation in patients with systemic RV.

Methods

Twenty-nine patients (mean age 34.7 ± 12.4 years) with a systemic RV (12 with congenitally corrected transposition of the great arteries (ccTGA) and 17 with atrially switched (TGA) underwent CMR. We compared measurements of systemic RV volumes and function using two analysis protocols. The RV trabeculations and papillary muscles were either included in the calculated blood volume, the boundary drawn immediately within the apparently compacted myocardial layer, or they were manually outlined and excluded. RV stroke volume (SV) calculated using each method was compared with corresponding left ventricular (LV) SV. Additionally, we compared the differences in analysis time, and in intra- and inter-observer variability between the two methods. Paired samples t-test was used to test for differences in volumes, function and analysis time between the two methods. Differences in intra- and inter-observer reproducibility were tested using an extension of the Bland-Altman method.

Results

The inclusion of trabeculations and papillary muscles in the ventricular volume resulted in higher values for systemic RV end diastolic volume (mean difference 28.7 ± 10.6 ml, p < 0.001) and for end systolic volume (mean difference 31.0 ± 11.5 ml, p < 0.001). Values for ejection fraction were significantly lower (mean difference -7.4 ± 3.9%, p < 0.001) if structures were included. LV SV did not differ significantly from RV SV for both analysis methods (p = NS). Including structures resulted in shorter analysis time (p < 0.001), and showed better inter-observer reproducibility for ejection fraction (p < 0.01).

Conclusion

The choice of method for systemic RV cavity delineation significantly affected volume measurements, given the CMR acquisition and analysis systems used. We recommend delineation outside the trabeculations for routine clinical measurements of systemic RV volumes as this approach took less time and gave more reproducible measurements.

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Budts W, Scheurwegs C, Stevens A, Moons P, Van DK, Vanhees L: The future of adult patients after Mustard or Senning repair for transposition of the great arteries. Int J Cardiol. 2006, 113: 209-214. 10.1016/j.ijcard.2005.11.015.CrossRefPubMed

Rutledge JM, Nihill MR, Fraser CD, Smith OE, McMahon CJ, Bezold LI: Outcome of 121 patients with congenitally corrected transposition of the great arteries. Pediatr Cardiol. 2002, 23: 137-145. 10.1007/s00246-001-0037-8.CrossRefPubMed

Tulevski II, Dodge-Khatami A, Groenink M, Van der Wall EE, Romkes H, Mulder BJ: Right ventricular function in congenital cardiac disease: noninvasive quantitative parameters for clinical follow-up. Cardiol Young. 2003, 13: 397-403.PubMed

Warnes CA: Transposition of the great arteries. Circulation. 2006, 114: 2699-2709. 10.1161/CIRCULATIONAHA.105.592352.CrossRefPubMed

Deanfield J, Thaulow E, Warnes C, Webb G, Kolbel F, Hoffman A, Sorenson K, Kaemmer H, Thilen U, Bink-Boelkens M, Iserin L, Daliento L, Silove E, Redington A, Vouhe P, Priori S, Alonso MA, Blanc JJ, Budaj A, Cowie M, Deckers J, Fernandez BE, Lekakis J, Lindahl B, Mazzotta G, Morais J, Oto A, Smiseth O, Trappe HJ, Klein W, Blomstrom-Lundqvist C, de BG, Hradec J, Mazzotta G, Parkhomenko A, Presbitero P, Torbicki A: Management of grown up congenital heart disease. Eur Heart J. 2003, 24: 1035-1084. 10.1016/S0195-668X(03)00131-3.CrossRefPubMed

van Son JA, Danielson GK, Huhta JC, Warnes CA, Edwards WD, Schaff HV, Puga FJ, Ilstrup DM: Late results of systemic atrioventricular valve replacement in corrected transposition. J Thorac Cardiovasc Surg. 1995, 109: 642-652. 10.1016/S0022-5223(95)70345-4.CrossRefPubMed

Voskuil M, Hazekamp MG, Kroft LJ, Lubbers WJ, Ottenkamp J, Van der Wall EE, Zwinderman KH, Mulder BJ: Postsurgical course of patients with congenitally corrected transposition of the great arteries. Am J Cardiol. 1999, 83: 558-562. 10.1016/S0002-9149(98)00913-8.CrossRefPubMed

Dodge-Khatami A, Tulevski II, Bennink GB, Hitchcock JF, de Mol BA, Van der Wall EE, Mulder BJ: Comparable systemic ventricular function in healthy adults and patients with unoperated congenitally corrected transposition using MRI dobutamine stress testing. Ann Thorac Surg. 2002, 73: 1759-1764. 10.1016/S0003-4975(02)03553-1.CrossRefPubMed

Groenink M, Mulder BJ, Van der Wall EE: Value of magnetic resonance imaging in functional assessment of baffle obstruction after the Mustard procedure. J Cardiovasc Magn Reson. 1999, 1: 49-51. 10.3109/10976649909080833.CrossRefPubMed

10.

Helbing WA, Rebergen SA, Maliepaard C, Hansen B, Ottenkamp J, Reiber JH, De RA: Quantification of right ventricular function with magnetic resonance imaging in children with normal hearts and with congenital heart disease. Am Heart J. 1995, 130: 828-837. 10.1016/0002-8703(95)90084-5.CrossRefPubMed

11.

Lorenz CH, Walker ES, Graham TP, Powers TA: Right ventricular performance and mass by use of cine MRI late after atrial repair of transposition of the great arteries. Circulation. 1995, 92: II233-II239.CrossRefPubMed

12.

Lorenz CH, Walker ES, Morgan VL, Klein SS, Graham TP: Normal human right and left ventricular mass, systolic function, and gender differences by cine magnetic resonance imaging. J Cardiovasc Magn Reson. 1999, 1: 7-21. 10.3109/10976649909080829.CrossRefPubMed

13.

Rominger MB, Bachmann GF, Pabst W, Rau WS: Right ventricular volumes and ejection fraction with fast cine MR imaging in breath-hold technique: applicability, normal values from 52 volunteers, and evaluation of 325 adult cardiac patients. J Magn Reson Imaging. 1999, 10: 908-918. 10.1002/(SICI)1522-2586(199912)10:6<908::AID-JMRI2>3.0.CO;2-2.CrossRefPubMed

14.

Sechtem U, Pflugfelder PW, Gould RG, Cassidy MM, Higgins CB: Measurement of right and left ventricular volumes in healthy individuals with cine MR imaging. Radiology. 1987, 163: 697-702.CrossRefPubMed

15.

Tulevski II, Van der Wall EE, Groenink M, Dodge-Khatami A, Hirsch A, Stoker J, Mulder BJ: Usefulness of magnetic resonance imaging dobutamine stress in asymptomatic and minimally symptomatic patients with decreased cardiac reserve from congenital heart disease (complete and corrected transposition of the great arteries and subpulmonic obstruction). Am J Cardiol. 2002, 89: 1077-1081. 10.1016/S0002-9149(02)02279-8.CrossRefPubMed

16.

Papavassiliu T, Kuhl HP, Schroder M, Suselbeck T, Bondarenko O, Bohm CK, Beek A, Hofman MM, van Rossum AC: Effect of endocardial trabeculae on left ventricular measurements and measurement reproducibility at cardiovascular MR imaging. Radiology. 2005, 236: 57-64. 10.1148/radiol.2353040601.CrossRefPubMed

17.

Sievers B, Kirchberg S, Bakan A, Franken U, Trappe HJ: Impact of papillary muscles in ventricular volume and ejection fraction assessment by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2004, 6: 9-16. 10.1081/JCMR-120027800.CrossRefPubMed

18.

Tulevski II, Romkes H, Dodge-Khatami A, Van der Wall EE, Groenink M, van Veldhuisen DJ, Mulder BJ: Quantitative assessment of the pressure and volume overloaded right ventricle: imaging is a real challenge. Int J Cardiovasc Imaging. 2002, 18: 41-51. 10.1023/A:1014315329767.CrossRefPubMed

19.

Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986, 1: 307-310.CrossRefPubMed

20.

Oosterhof T, Tulevski II, Vliegen HW, Spijkerboer AM, Mulder BJ: Effects of volume and/or pressure overload secondary to congenital heart disease (tetralogy of fallot or pulmonary stenosis) on right ventricular function using cardiovascular magnetic resonance and B-type natriuretic peptide levels. Am J Cardiol. 2006, 97: 1051-1055. 10.1016/j.amjcard.2005.10.047.CrossRefPubMed

21.

Pattynama PM, Lamb HJ, Van der Velde EA, Van der Geest RJ, Van der Wall EE, De RA: Reproducibility of MRI-derived measurements of right ventricular volumes and myocardial mass. Magn Reson Imaging. 1995, 13: 53-63. 10.1016/0730-725X(94)00076-F.CrossRefPubMed

22.

Alfakih K, Reid S, Jones T, Sivananthan M: Assessment of ventricular function and mass by cardiac magnetic resonance imaging. Eur Radiol. 2004, 14: 1813-1822. 10.1007/s00330-004-2387-0.CrossRefPubMed

23.

Beygui F, Furber A, Delepine S, Helft G, Metzger JP, Geslin P, Le Jeune JJ: Routine breath-hold gradient echo MRI-derived right ventricular mass, volumes and function: accuracy, reproducibility and coherence study. Int J Cardiovasc Imaging. 2004, 20: 509-516. 10.1007/s10554-004-1097-7.CrossRefPubMed

24.

Grothues F, Moon JC, Bellenger NG, Smith GS, Klein HU, Pennell DJ: Interstudy reproducibility of right ventricular volumes, function, and mass with cardiovascular magnetic resonance. Am Heart J. 2004, 147: 218-223. 10.1016/j.ahj.2003.10.005.CrossRefPubMed

25.

Tandri H, Daya SK, Nasir K, Bomma C, Lima JA, Calkins H, Bluemke DA: Normal reference values for the adult right ventricle by magnetic resonance imaging. Am J Cardiol. 2006, 98: 1660-1664. 10.1016/j.amjcard.2006.07.049.CrossRefPubMed

26.

Lidegran M, Odhner L, Jacobsson LA, Greitz D, Lundell B: Magnetic resonance imaging and echocardiography in assessment of ventricular function in atrially corrected transposition of the great arteries. Scand Cardiovasc J. 2000, 34: 384-389. 10.1080/14017430050196207.CrossRefPubMed

27.

Lissin LW, Li W, Murphy DJ, Hornung T, Swan L, Mullen M, Kilner P, Gatzoulis MA: Comparison of transthoracic echocardiography versus cardiovascular magnetic resonance imaging for the assessment of ventricular function in adults after atrial switch procedures for complete transposition of the great arteries. Am J Cardiol. 2004, 93: 654-657. 10.1016/j.amjcard.2003.11.044.CrossRefPubMed

Title: Evaluating the systemic right ventricle by CMR: the importance of consistent and reproducible delineation of the cavity
Authors: Michiel M Winter
Flip JP Bernink
Maarten Groenink
Berto J Bouma
Arie PJ van Dijk
Willem A Helbing
Jan GP Tijssen
Barbara JM Mulder
Publication date: 01-12-2008
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2008
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/1532-429X-10-40

At a glance: The STEP trials

Springer Medicine

Evaluating the systemic right ventricle by CMR: the importance of consistent and reproducible delineation of the cavity

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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