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

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 card...

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Autores principales: Winter, Michiel M, Bernink, Flip JP, Groenink, Maarten, Bouma, Berto J, van Dijk, Arie PJ, Helbing, Willem A, Tijssen, Jan GP, Mulder, Barbara JM
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2533306/
https://www.ncbi.nlm.nih.gov/pubmed/18713464
http://dx.doi.org/10.1186/1532-429X-10-40
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author Winter, Michiel M
Bernink, Flip JP
Groenink, Maarten
Bouma, Berto J
van Dijk, Arie PJ
Helbing, Willem A
Tijssen, Jan GP
Mulder, Barbara JM
author_facet Winter, Michiel M
Bernink, Flip JP
Groenink, Maarten
Bouma, Berto J
van Dijk, Arie PJ
Helbing, Willem A
Tijssen, Jan GP
Mulder, Barbara JM
author_sort Winter, Michiel M
collection PubMed
description 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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spelling pubmed-25333062008-09-11 Evaluating the systemic right ventricle by CMR: the importance of consistent and reproducible delineation of the cavity Winter, Michiel M Bernink, Flip JP Groenink, Maarten Bouma, Berto J van Dijk, Arie PJ Helbing, Willem A Tijssen, Jan GP Mulder, Barbara JM J Cardiovasc Magn Reson Research 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. BioMed Central 2008-08-19 /pmc/articles/PMC2533306/ /pubmed/18713464 http://dx.doi.org/10.1186/1532-429X-10-40 Text en Copyright © 2008 Winter et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Winter, Michiel M
Bernink, Flip JP
Groenink, Maarten
Bouma, Berto J
van Dijk, Arie PJ
Helbing, Willem A
Tijssen, Jan GP
Mulder, Barbara JM
Evaluating the systemic right ventricle by CMR: the importance of consistent and reproducible delineation of the cavity
title Evaluating the systemic right ventricle by CMR: the importance of consistent and reproducible delineation of the cavity
title_full Evaluating the systemic right ventricle by CMR: the importance of consistent and reproducible delineation of the cavity
title_fullStr Evaluating the systemic right ventricle by CMR: the importance of consistent and reproducible delineation of the cavity
title_full_unstemmed Evaluating the systemic right ventricle by CMR: the importance of consistent and reproducible delineation of the cavity
title_short Evaluating the systemic right ventricle by CMR: the importance of consistent and reproducible delineation of the cavity
title_sort evaluating the systemic right ventricle by cmr: the importance of consistent and reproducible delineation of the cavity
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2533306/
https://www.ncbi.nlm.nih.gov/pubmed/18713464
http://dx.doi.org/10.1186/1532-429X-10-40
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