Right ventricular ejection fraction measurements using two-dimensional transthoracic echocardiography by applying an ellipsoid model

BACKGROUND: There is today no established approach to estimate right ventricular ejection fraction (RVEF) using 2D transthoracic echocardiography (TTE). The aim of this study was to evaluate a new method for RVEF calculations using 2D TTE and compare the results with cardiac magnetic resonance (CMR) imaging and tricuspid annular plane systolic excursion (TAPSE). METHODS: A total of 37 subjects, 25 retrospectively included patients and twelve healthy volunteers, were included to give a wide range of RVEF. The right ventricle (RV) was modeled as a part of an ellipsoid enabling calculation of the RV volume by combining three distance measurements. RVEF calculated according to the model, RVEF(TTE), were compared with reference CMR-derived RVEF, RVEF(CMR). Further, TAPSE was measured in the TTE images and the correlations were calculated between RVEF(TTE), TAPSE and RVEF(CMR). RESULTS: The mean values were RVEF(CMR) = 43 ± 12% (range 20–66%) and RVEF(TTE) = 50 ± 9% (range 34–65%). There was a high correlation (r = 0.80, p < 0.001) between RVEF(TTE) and RVEF(CMR). Bland-Altman analysis showed a mean difference between RVEF(CMR) and RVEF(TTE) of 6 percentage points (ppt) with limits of agreement from −11 to 23 ppt. The mean value for TAPSE was 19 ± 5 mm and the correlation between TAPSE and RVEF(CMR) was moderate (r = 0.54, p < 0.001). The correlation between RVEF(TTE) and RVEF(CMR) was significantly higher (p < 0.05) than the correlation between TAPSE and RVEF(CMR). CONCLUSIONS: The ellipsoid model shows promise for RVEF calculations using 2D TTE for a wide range of RVEF, providing RVEF estimates that were significantly better correlated to RVEF obtained from CMR compared to TAPSE. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12947-017-0096-5) contains supplementary material, which is available to authorized users.