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AIMS: (i) To validate a new software for right ventricular (RV) analysis by 3D echocardiography (3DE) against cardiac magnetic resonance (CMR); (ii) to assess the accuracy of different measurement approaches; and (iii) to explore any benefits vs. the previous software.METHODS AND RESULTS: We prospectively studied with 3DE and CMR 47 patients (14-82 years, 28 men) having a wide range of RV end-diastolic volumes (EDV 82-354 mL at CMR) and ejection fractions (EF 34-81%). Multi-beat RV 3DE data sets were independently analysed with the new software using both automated and manual editing options, as well as with the previous software. RV volume reproducibility was tested in 15 random patients. RV volumes and EF measurements by the new software had an excellent accuracy (bias ± SD: -15 ± 24 mL for EDV; 1.4 ± 4.9% for EF) and reproducibility compared with CMR, provided that the RV borders automatically tracked by software were systematically edited by operator. The automated analysis option underestimated the EDV, overestimated the ESV, and largely underestimated the EF (bias ± SD: -17 ± 10%). RV volumes measured with the new software using manual editing showed similar accuracy, but lower inter-observer variability and shorter analysis time (3-5') in comparison with the previous software.CONCLUSION: Novel vendor-independent 3DE software enables an accurate, reproducible and faster quantitation of RV volumes and ejection fraction. Rather than optional, systematic verification of border tracking quality and manual editing are mandatory to ensure accurate 3DE measurements. These findings are relevant for echocardiography laboratories aiming to implement 3DE for RV analysis for both research and clinical purposes.

Background: Quantitative analysis of mitral valve (MV) can discriminate among various mechanisms causing valve insufficiency. There are no established reference values for MV geometry, nor data on its feasibility and reproducibility with latest transthoracic 3D echocardiography (3DTTE). Methods: Eighty-one consecutive healthy volunteers (43+13 years, range 18-70; 33 men) with good apical window underwent a 3D full-volume acquisition of MV apparatus (32+2 vps) using Vivid E9 (BT 12, GE Healthcare, Horten, N). MV datasets were analyzed offline using a software recently developed for 3DTTE (TomTec MV assessment 2.0, Unterschleissheim, D). Intra- and inter-observer reproducibility were assessed in 15 subjects and expressed as intraclass correlation coefficients (ICC). Results: Five subjects were excluded due to low quality of 3D dataset with poor MV tracking (feasibility 94%). The average analysis time of one dataset (including manual editing) was 2’. Reference values of MV parameters and their reproducibility are reported in Table. Leaflet tenting and annulus measures were positively correlated with body surface area (BSA, r=0.34-0.53, p , 0.001), but not with age. After correcting for BSA, there were no gender differences in MV parameters. Conclusion: Quantitative analysis of MV by 3DTTE is highly feasible and reproducible, and reference values are reported. Our findings may support the implementation of MV quantitative analysis by 3DTTE in clinical settings.

Background: Tricuspid annulus (TA) size and function plays an important role in decision-making process about the need of associated TA annuloplasty during left sided cardiac surgery. Recommendations about echo assessment of TA don't indicate the view and the timing where TA should be measured. Our aim was to study TA diameters and shortening in different 2D TTE views to assess the extent of their variability. Methods: Cross-sectional study of normal volunteers. TA was measured from 3 2DTTE views (apical 4-CH, LAX-RV inflow, SAX basal) at 5 time points during cardiac cycle. TA fractional shortening diameter was obtained as (TV opening early-filling – Mid-systole) / TV opening early-filling. Result: 100pts; 42%male; 44±13yrs. TA diameters are in the Table. Fractional shortening of TA was 22±7%, 18±8%, 31±16% in 4-CH, LAX-RV inflow and SAX basal views respectively. Conclusion: This study support new references values for TA evaluation using 2D TTE. Values vary according to 2D TTE view and cardiac cycle time, showing the dynamism and complex geometry of TA