Right ventricular volume and function by three-dimensional echocardiography: results of the echocardiographic measurements in normal Chinese adults (EMINCA) II

Abstract

Three-dimensional (3D) echocardiography is an emerging technique for assessing right ventricular (RV) volume and function, but 3D-RV normal values from a large Chinese population are still lacking. The aim of the present study was to establish normal values of 3D-RV volume and function in healthy Chinese volunteers. A total of 1117 Han Chinese volunteers from 28 laboratories in 20 provinces of China were enrolled, and 3D-RV images of 747 volunteers with optimal image quality were ultimately analyzed by a core laboratory. Both vendor-dependent and vendor-independent software platforms were used to analyze the 3D-RV images. We found that men had larger RV volumes than women did in the whole population, even after indexing to body surface area, and older individuals had smaller RV volumes. The normal RV volume was significantly smaller than that recommended by the American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines in both sexes. There were significant differences in 3D-RV measurements between the two vendor ultrasound systems and the different software platforms. The echocardiographic measurements in normal Chinese adults II study revealed normal 3D-RV volume and function in a large Chinese population, and there were significant differences between the sexes, ages, races, and vendor groups. Thus, normal 3D-RV values should be stratified by sex, age, race, and vendor.

References

1	NJ Shelburne, KS Parikh, K Chiswell, et al. Echocardiographic assessment of right ventricular function and response to therapy in pulmonary arterial hypertension. Am J Cardiol. 2019;124(8):1298-1304.
2	J Sanz, D Sánchez-Quintana, E Bossone, HJ Bogaard, R Naeije. Anatomy, function, and dysfunction of the right ventricle: JACC state-of-the-art review. J Am Coll Cardiol. 2019;73(12):1463-1482.
3	F Lahm, IS Douglas, SL Archer, et al. Assessment of right ventricular function in the research setting: knowledge gaps and pathways forward. An official American Thoracic Society Research Statement. Am J Respir Crit Care Med. 2018;198(4):e15-e43.
4	MP DiLorenzo, SM Bhatt, L Mercer-Rosa. How best to assess right ventricular function by echocardiography. Cardiol Young. 2015;25(8):1473-1481.
5	OK Khalique, JL Cavalcante, D Shah, et al. Multimodality imaging of the tricuspid valve and right heart anatomy. JACC Cardiovasc Imaging. 2019;12(3):516-531.
6	S Venkatachalam, G Wu, M Ahmad. Echocardiographic assessment of the right ventricle in the current era: application in clinical practice. Echocardiography. 2017;34(12):1930-1947.
7	S Wang, S Wang, Q Zhu, et al. Reference values of right ventricular volumes and ejection fraction by three-dimensional echocardiography in adults: a systematic review and meta-analysis. Front Cardiovasc Med. 2021;8:709863.
8	LG Rudski, WW Lai, J Afilalo, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685-713.
9	G Tamborini, NA Marsan, P Gripari, et al. Reference values for right ventricular volumes and ejection fraction with real-time three-dimensional echocardiography: evaluation in a large series of normal subjects. J Am Soc Echocardiogr. 2010;23(2):109-115.
10	F Maffessanti, D Muraru, R Esposito, et al. Age-, body size-, and sex-specific reference values for right ventricular volumes and ejection fraction by three-dimensional echocardiography. Circ Cardiovasc Imaging. 2013;6(5):700-710.
11	K Addetia, T Miyoshi, V Amuthan, et al. Normal values of three-dimensional right ventricular size and function measurements: results of the World Alliance Societies of Echocardiography study. J Am Soc Echocardiogr. 2023;36(8):858-866.
12	H Baumgartner, J Hung, J Bermejo, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233-271.
13	GH Yao, Y Deng, Y Liu, et al. Echocardiographic measurements in normal Chinese adults focusing on cardiac chambers and great arteries: a prospective, nationwide, and multicenter study. J Am Soc Echocardiogr. 2015;28(5):570-579.
14	GH Yao, M Zhang, LX Yin, et al. Doppler echocardiographic measurements in normal Chinese adults (EMINCA): a prospective, nationwide, and multicentre study. Eur Heart J Cardiovasc Imaging. 2016;17(5):512-522.
15	L Wang, Y Xing, XW Yu, et al. Greater macrovascular and microvascular morbidity from type 2 diabetes in northern compared with southern China: a cross-sectional study. J Diabetes Investig. 2020;11(5):1285-1294.
16	FM Asch, T Miyoshi, K Addetia, et al. Similarities and differences in left ventricular size and function among races and nationalities: results of the World Alliance Societies of Echocardiography Normal Values Study. J Am Soc Echocardiogr. 2019;32(11):1396-1406.e2.
17	A D'Andrea, L Riegler, S Morra, et al. Right ventricular morphology and function in top-level athletes: a three-dimensional echocardiographic study. J Am Soc Echocardiogr. 2012;25(12):1268-1276.
18	K Addetia, F Maffessanti, D Muraru, et al. Morphologic analysis of the normal right ventricle using three-dimensional echocardiography-derived curvature indices. J Am Soc Echocardiogr. 2018;31(5):614-623.
19	BK Lakatos, Y Nabeshima, M Tokodi, et al. Importance of nonlongitudinal motion components in right ventricular function: three-dimensional echocardiographic study in healthy volunteers. J Am Soc Echocardiogr. 2020;33(8):995-1005.e1.
20	TD Potter, C Weytjens, A Motoc, et al. Feasibility, reproducibility and validation of right ventricular volume and function assessment using three-dimensional echocardiography. Diagnostics. 2021;11(4):699.
21	SM Kawut, JA Lima, RG Barr, et al. Sex and race differences in right ventricular structure and function the multi-ethnic study of atherosclerosis-right ventricle study. Circulation. 2011;123(22):2542-2551.
22	CM Abouzeid, T Shah, A Johri, JW Weinsaft, J Kim. Multimodality imaging of the right ventricle. Curr Treat Options Cardiovasc Med. 2017;19(11):82.
23	K Addetia, T Miyoshi, V Amuthan, et al. Normal values of left ventricular size and function on three-dimensional echocardiography: results of the World Alliance Societies of Echocardiography study. J Am Soc Echocardiogr. 2022;35(5):449-459.
24	GH Yao, XY Chen, Q Zhang, et al. A novel mathematical model for correcting the physiologic variance of two-dimensional echocardiographic measurements in healthy Chinese adults. J Am Soc Echocardiogr. 2019;32(7):876-883.
25	Y Nabeshima, K Addetia, FM Asch, RM Lang, M Takeuchi. Application of the allometric methods for indexation of left ventricular end-diastolic volume to normal echocardiographic data and assessing gender and racial differences. J Am Soc Echocardiogr. 2023;36(6):596-603.
26	K Otani, Y Nabeshima, T Kitano, M Takeuchi. Accuracy of fully automated right ventricular quantification software with 3D echocardiography: direct comparison with cardiac magnetic resonance and semi-automated quantification software. Eur Heart J Cardiovasc Imaging. 2020;21(7):787-795.
27	D DuBois, EF DuBois. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med. 1961;17: 863-871.
28	RM Lang, LP Badano, W Tsang, et al. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging. 2012;13(1):1-46.
29	A Vitarelli, E Mangieri, C Terzano, et al. Three-dimensional echocardiography and 2D-3D speckle-tracking imaging in chronic pulmonary hypertension: diagnostic accuracy in detecting hemodynamic signs of right ventricular (RV) failure. J Am Heart Assoc. 2015;4(3):e001584.
30	D Medvedofsky, K Addetia, AR Patel, et al. Novel approach to three-dimensional echocardiographic quantification of right ventricular volumes and function from focused views. J Am Soc Echocardiogr. 2015;28(10):1222-1231.