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METHODS article

Front. Cardiovasc. Med.

Sec. General Cardiovascular Medicine

Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1523338

This article is part of the Research TopicThe Right Heart: A Key Target for Cardiovascular MedicineView all 7 articles

From Novice to Expert: The Reproducibility of 3D Echocardiographic Right Ventricular Assessment in Heart Failure Patients

Provisionally accepted
Hayat  MemisHayat Memis1,2Sorina  Baldea MihailaSorina Baldea Mihaila1,2*Diana  MihalceaDiana Mihalcea1,2Adriana  AndreescuAdriana Andreescu2Diana  DoditaDiana Dodita2Beatrice  SpataruBeatrice Spataru2Andreea-Elena  VelceaAndreea-Elena Velcea1,2Alina  NiculaAlina Nicula3Dragos  VinereanuDragos Vinereanu1,2
  • 1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  • 2University and Emergency Hospital of Bucharest, Department of Cardiology and Cardiovascular Surgery, Bucharest, Romania
  • 3University and Emergency Hospital of Bucharest, Department of Radiology, Bucharest, Romania

The final, formatted version of the article will be published soon.

Background: Right ventricular (RV) function is a key prognostic factor in patients with heart failure with mildly reduced (HFmrEF) or reduced ejection fraction (HFrEF). While two-dimensional echocardiography (2DE) is used due to its availability, three-dimensional echocardiography (3DE) provides more reproducible measurements, though its use is limited by training requirements. Objective: To assess whether cardiologists experienced in 2DE with limited 3DE exposure can obtain feasible and reproducible 3DE measurements of RV size and function after a short training in patients with HFmrEF/HFrEF. Methods: 161 patients hospitalized for decompensated HFmrEF/HFrEF (mean age 58±17 years, 71% males, 3D LVEF 35±10%) were analyzed in the study using 2DE and 3DE assessments. Measurements were performed by an Expert in 2DE and 3DE, and by a Beginner with experience in 2DE but only three months of practical training in 3DE. Measurements were taken at baseline (T0) and after three months of practical training in 3DE (T1) to assess intra- and inter-observer reproducibility. Results: The study demonstrated high intra-observer reproducibility for 2DE parameters by the Beginner with 95% ICCs of: 0.98 (0.98-0.99) for RV diameter, 0.97 (0.94-0.98) for TAPSE, 0.92 (0.90-0.99) for RVFAC, 0.96 (0.95-0.98) for S’, and 0.98 (0.97-0.99) for RVFWS. Conversely, there was a slightly lower inter-observer reproducibility compared to the Expert for the same 2D parameters, with ICCs of: 0.81 (0.71-0.87) for RV diameter, 0.91 (0.88-0.94) for TAPSE, 0.86 (0.81-0.90) for RVFAC, 0.90 (0.88-0.93) for S’, and 0.93 (0.85-0.96) for RVFWS, respectively. The Beginner’s intra-observer reproducibility for 3DE parameters was good at baseline, after short theoretical training in 3DE, with ICCs of: 0.87 (0.83-0.91) for RVEDV, 0.85 (0.79-0.89) for RVESV, and 0.90 (0.87-0.93) for RVEF, respectively, and improved significantly after 3 months of practice in 3DE, with ICCs of: 0.96 (0.92-0.97) for RVEDV, 0.95 (0.94-0.98) for RVESV, and 0.95 (0.91-0.97) for RVEF. Bland-Altman analysis showed no systematic bias between the Expert and Beginner for both 2DE and 3DE measurements, confirming the robustness of 3DE across different experience levels. Conclusions: After brief training, 2DE-proficient cardiologists can perform accurate and reproducible 3DE measurements of RV function, supporting broader clinical use of 3DE in heart failure assessment.

Keywords: Heart Failure, Right ventricle dysfunction, reproducibility, Reliability, three-dimensional echocardiography, Beginner, expert right ventricle, three-dimensional echocardiography, two-dimensional echocardiography, reproducibility, cardiac function, heart failure

Received: 05 Nov 2024; Accepted: 04 Aug 2025.

Copyright: © 2025 Memis, Mihaila, Mihalcea, Andreescu, Dodita, Spataru, Velcea, Nicula and Vinereanu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Sorina Baldea Mihaila, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

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