@Article{CHD.2020.011376,
AUTHOR = {Karina V. Bunting, Francesco Formisano, Jennifer Green, Richard P. Steeds, Lucy Hudsmith, Paul Clift},
TITLE = {Assessing Univentricular Function in Adult Fontan Using 3D  Echocardiography},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {15},
YEAR = {2020},
NUMBER = {2},
PAGES = {89--100},
URL = {http://www.techscience.com/schd/v15n2/39429},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> To determine the accuracy of assessing univentricular 
function in adult Fontan patients using three-dimensional (3D) volumetric 
echocardiography. <b>Design:</b> A prospective observational study in an adult Fontan 
patient cohort. <b>Setting:</b> University Hospitals Birmingham, NHS Foundation 
Trust. <b>Patients:</b> 26 patients were enrolled in the study all aged over 18 years, 
possessing the Fontan anatomy, with no contraindications to Cardiac Magnetic 
Resonance (CMR) imaging and in sinus rhythm. <b>Intervention:</b> All patients 
underwent transthoracic echocardiography using a Philips EPIQ 7 and X5-1
transducer. End diastolic volume (EDV), end systolic volume (ESV), stroke 
volume (SV) and ejection fraction (EF) were obtained using two dimensional 
(2D) and 3D acquisitions. CMR was performed within 3 months according to 
standard protocols. <b>Outcome Measures:</b> The agreement and correlation between 
2D, 3D and CMR derived parameters were determined by Bland and Altman 
analysis and Pearson’s correlation coefficient method. The inter-observer 
variability was also assessed for all three modalities. <b>Results:</b> 3D volumetric 
acquisitions of the single ventricle were feasible in 18/26 (69%) patients. 3D 
volumes strongly correlated with CMR but with a systematic bias to underestimation: EDV r = 0.66, bias = –47.1 (–109.6 to 15.2); ESV r = 0.82, bias = –
19.4 (–59.9 to 21.1); EF r = 0.73, –1.56 (–18.8 to 15.7) and SV r = 0.32, –27.7 (–
70.2 to 14.7). Inter-observer variability was lowest with CMR, when compared 
to echocardiographic techniques. The inter-observer variability for 3D when 
compared with 2D echocardiography was lower across all parameters except 
EDV. <b>Conclusions:</b> 3D volumes correlate strongly with CMR and may be used 
for serial assessment of univentricular function. However, 3D volumes on echo 
are not interchangeable with CMR due to systematic underestimation of volume.},
DOI = {10.32604/CHD.2020.011376}
}